Hadron therapy in HCC
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Transcript of Hadron therapy in HCC
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HADRON THERAPY IN
HEPATOCELLULAR CARCINOMA
Mayur Mayank
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What is a Hadron ?
• Term introduced by Lev Borisovich Okun in 1962 at International Conference on High Energy Physics.
• It is a composite particle made of quarks which
experience the strong nuclear force.
Protons
Neutrons
Pions
Kaons
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Hadron Therapy
• Other name of Particle Beam Therapy
• Proton Beam Therapy
• Fast Neutron Therapy
• Heavy Ion Therapy
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Hepatocellular Cancer
• 5th most common cancer worldwide
• 3rd most common cause of cancer mortality worldwide
• Extremely aggressive tumor
• Poor survival
• 5 year survival : 3-5%
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• Management approaches for localised HCC :• Surgical Resection
• Liver Transplantation
• Percutaneous Ablation
• Transcatheter Arterial chemoembolization (TACE)
• Radiation Therapy
• Systemic chemotherapy
• Molecular targeted agents
Hepatocellular Cancer
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Hepatocellular Cancer
• HCC is a radiosensitive tumor
• Major drawback of radiotherapy in treating HCC • Poor radiation tolerance of adjacent normal liver
• Difficulty of tumor localization
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Hepatocellular Cancer
• Indications for Radiotherapy : • Large unresectable HCC
• Relieving portal vein thrombosis and obstructive jaundice
• Failure of prior TACE
• As part of combined modality treatment with TACE, and percutaneous ablation therapy
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Rationale of Particle Therapy in HCC
• Radiation Induced Liver Damage (RILD)• Anicteric hepatomegaly
• Ascitis
• Elevated liver enzymes
• Radiation therapy dose constraints for liver – QUANTEC
2 weeks to 3 months after External Beam radiation therapy
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Rationale of Particle Therapy in HCC
• Dosimetric advantage• Spread out Bragg Peak (SOBP)
• Higher RBE
• Low OER
• Dose escalation
• Decreased radiation dose to nearby structures
• Decreased dose to the normal liver
• Less integral dose
Seen with Carbon Ion Therapy
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Proton
Photon
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Proton Beam Therapy in HCC
• Retrospective and Prospective studies have shown overall survival and loco regional control advantage
• Dosimetric advantage with SOBP helps in delivering high doses to the tumor with limiting normal tissue toxicity• Increased Therapeutic Index
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Local tumor control after proton beam therapy
Actual survival for all the patientsSurvival for patients with least impaired hepatic function
(chronic hepatitis or Child-Pugh class A cirrhosis) and a solitary
tumor.
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Progression Free Survival
Overall Survival
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Carbon Ion Therapy in HCC
• Carbon ions have the dosimetric advantage of Proton beams
• Added advantage of :• Increased RBE
• Low OER
• Prospective study done at Japan has shown good local control with survival advantage.
• Optimal dose still not found – Phase I study underway
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Challenges in Hadron Therapy
• Difficulty establishing advantage of hadron therapy over competing therapies
– Inadequate statistics at individual clinics– Lack of uniformity in treatment techniques– Lack of money to support clinical trials
• Number of hadron facilities is small
• High Costs– Each hadron clinic has one-of-a-kind accelerator
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Conclusions
• Hadron Therapy (Particle Therapy) – Exciting and promising approach for treating HCC
• Studies till date have shown both loco regional control and survival advantage with limited toxicity
• Limited resources are a major hindrance in development of Hadron Therapy
• Further studies needed to make Hadron Therapy a standard of care in management of Hepatocellular Carcinomas