Clin Mol Hepatol.  2023 Oct;29(4):958-968. 10.3350/cmh.2023.0274.

Current evidence and the potential role of proton beam therapy for hepatocellular carcinoma

  • 1Center for Proton Therapy, National Cancer Center, Goyang, Korea
  • 2Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea


Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, and external beam radiation therapy has emerged as a promising approach for managing HCC. Proton beam therapy (PBT) offers dosimetric advantages over X-ray therapy, with superior physical properties known as the Bragg peak. PBT holds promise for reducing hepatotoxicity and allowing safe dose-escalation to the tumor. It has been tried in various clinical conditions and has shown promising local tumor control and survival outcomes. A recent phase III trial demonstrated the non-inferiority of PBT in local tumor control compared to current standard radiofrequency ablation in early-stage HCC. PBT also tended to show more favorable outcomes compared to transarterial chemoembolization in the intermediate stage, and has proven effective in-field disease control and safe toxicity profiles in advanced HCC. In this review, we discuss the rationale, clinical studies, optimal indication, and future directions of PBT in HCC treatment.


Carcinoma; hepatocellular; Radiotherapy; Proton therapy
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