ArticleBMC cancer2026
Efficacy and safety of carbon-ion radiotherapy for large hepatocellular carcinoma (diameter ≥ 10 cm).
Article in BMC cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLarge, unresectable hepatocellular carcinoma (HCC) remains incurable, and the risk of radiation-induced liver damage makes definitive radiotherapy challenging. We aimed to evaluate the efficacy and safety of carbon-ion radiotherapy (CIRT).
methodsWe retrospectively analyzed records of 33 CIRT-treated patients with HCC (diameter ≥ 10 cm) at Osaka Heavy Ion Therapy Center. Rates of local control (LC), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Toxicities were evaluated according to the Common Terminology Criteria for Adverse Events v5.0.
resultsThe median tumor diameter was 11 (range: 10-18) cm. Stage IB was the most common disease stage, and alcoholic liver disease was the most common underlying condition. The relative biological effectiveness-weighted dose was 60 Gy/4 fractions, 67.2 Gy/12 fractions, and 60 Gy/12 fractions in 19, 8, and 6 patients, respectively. Based on pretreatment liver function, 27 and 6 patients were categorized as Child-Pugh classes A and B, respectively. The median follow-up period was 15.1 (range: 2.8-54.0) months. The 1-year LC, PFS, and OS rates were 85.9%, 30.0%, and 74.8%, respectively. Grade ≥ 3 toxicities included pleural effusion in two patients (6%) and hepatic failure, heart failure, bile duct stricture, and biliary tract infection in one patient (3%) each. No grade ≥ 4 toxicities occurred. Radiation-induced liver damage, defined as a Child-Pugh score increase ≥ 2 points from the pretreatment baseline, occurred in five patients (15%).
conclusionsCIRT for large HCC (≥ 10 cm) was effective in the short term, with acceptable toxicities. However, the short follow-up may have led to an underestimation of the incidence of late complications.
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