For large HCCs, if the normal tissue complication probability is unacceptably high for a 5-fraction photon SBRT plan but is acceptable for a 5-fraction proton SBRT, would you recommend 5 fractions of protons or 15 fractions of photons?
This question is part of our ASTRO 2026 collaboration, inspired by the Plenary Session Presentation "Initial Results of NRG Oncology NRG-GI003: A Phase III Randomized Trial of Protons vs. Photons for Hepatocellular Carcinoma (HCC)" by Dr. Theodore Hong, MD
1 Answer
Mednet MemberInvited Expert
Radiation Oncology · Harvard Medical School.
Answered on
No, this is not recommended in light of the unexpected finding that patients with tumors over 5 cm had a worse outcome with protons on multivariable analysis. This finding is puzzling, and we will be doing further analysis to understand it.
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