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. 2025 Jul 17;17(14):2369.
doi: 10.3390/cancers17142369.

NRG Oncology Liver Proton SBRT and Hypofractionated Radiation Therapy: Current Treatment Technical Assessment and Practice Patterns

Minglei Kang  1   2 , Paige A Taylor  3 , Jiajian Shen  4 , Jun Zhou  5 , Jatinder Saini  6 , Theodore S Hong  7 , Kristin Higgins  8 , Wei Liu  4 , Ying Xiao  9 , Charles B Simone 2nd  1 , Liyong Lin  5
Affiliations

NRG Oncology Liver Proton SBRT and Hypofractionated Radiation Therapy: Current Treatment Technical Assessment and Practice Patterns

Minglei Kang et al. Cancers (Basel). .

Abstract

Background/Objectives: Proton therapy delivers highly conformal doses to the target area without producing an exit dose, minimizing cumulative doses to healthy liver tissue. This study aims to evaluate current practices, challenges, and variations in the implementation of proton stereotactic body radiation therapy (SBRT) and hypofractionated therapy for liver malignancies, with the goal of providing a technical assessment to promote broader adoption and support future clinical trials. Methods and Materials: An extensive survey was conducted by NRG Oncology across North American proton treatment centers to assess the current practices of proton liver SBRT and hypofractionated therapy. The survey focused on key aspects, including patient selection, prescription and normal tissue constraints, simulation and motion management, treatment planning, quality assurance (QA), treatment delivery, and the use of image-guided radiation therapy (IGRT). Results: This survey captures the current practice patterns and status of proton SBRT and hypofractionated therapy in liver cancer treatment. Proton therapy is increasingly preferred for treating inoperable liver malignancies due to its ability to minimize healthy tissue exposure. However, the precision required for proton therapy presents challenges, particularly in managing uncertainties and target motion during high-dose fractions and short treatment courses. Survey findings revealed significant variability in clinical practices across centers, highlighting differences in motion management, dose fractionation schedules, and QA protocols. Conclusion: Proton SBRT and hypofractionated therapy offer significant potential for treating liver malignancies. A comprehensive approach involving precise patient selection, treatment planning, and QA is essential for ensuring safety and effectiveness. This survey provides valuable insights into current practices and challenges, offering a foundation for technical recommendations to optimize the use of proton therapy and guide future clinical trials.

Keywords: hypofractionated therapy; image-guided radiation therapy; liver; proton therapy; stereotactic body radiation therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The statistics of the tumor diameter in (a) and the dose-fractionation regimes in (b) for proton SBRT and hypofractionated therapy.
Figure 2
Figure 2
Target delineation protocols, utilization of fiducial markers, target motion evaluation, and CT slice thickness choice.
Figure 3
Figure 3
The statistics from the treatment planning and QA survey results for liver SBRT and hypofractionation therapy.
Figure 4
Figure 4
Image-guided radiation therapy used in liver SBRT and hypofractionation treatments.
See this image and copyright information in PMC

References

    1. Roberts H.J., Wo J.Y. Stereotactic body radiation therapy for primary liver tumors: An effective liver-directed therapy in the toolbox. Cancer. 2022;128:956–965. doi: 10.1002/cncr.34033. - DOI - PubMed
    1. Klein J., Dawson L.A. Hepatocellular carcinoma radiation therapy: Review of evidence and future opportunities. Int. J. Radiat. Oncol. Biol. Phys. 2013;87:22–32. doi: 10.1016/j.ijrobp.2012.08.043. - DOI - PubMed
    1. Aitken K.L., Hawkins M.A. Stereotactic body radiotherapy for liver metastases. Clin. Oncol. 2015;27:307–315. doi: 10.1016/j.clon.2015.01.032. - DOI - PubMed
    1. Rusthoven K.E., Kavanagh B.D., Cardenes H., Stieber V.W., Burri S.H., Feigenberg S.J., Chidel M.A., Pugh T.J., Franklin W., Kane M., et al. Multi-institutionalphase I/II trial of stereotactic body radiation therapy for liver metastases. J. Clin. Oncol. 2009;27:1572–1578. doi: 10.1200/JCO.2008.19.6329. - DOI - PubMed
    1. Goodman B.D., Mannina E.M., Althouse S.K., Maluccio M.A., Cárdenes H.R. Longterm safety and efficacy of stereotactic body radiation therapy for hepatic oligometastases. Pract. Radiat. Oncol. 2016;6:86–95. doi: 10.1016/j.prro.2015.10.011. - DOI - PubMed

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