A MD Anderson study published in the Green Journal reported outcomes of forty-six patients with HCC, Child-Pugh class of A or B, no prior radiotherapy treated with PBT to a total dose of 97.7 GyE (range, 33.6-144 GyE) administered in 15 fractions. Actuarial 2-year LC and OS rates were 81% and 62% respectively; median OS was 30.7 months. Patients receiving BED ≥90 GyE had a significantly better OS than those receiving BED <90 GyE.

The most common toxicities were grade 1 fatigue (33%), skin erythema (24%), nausea (22%), anorexia (11%) and vomiting (13%). Acute grade 3 toxicities were recorded in 6 (13%) patients. No grade 3 or greater CTCAE hepatic toxicity or classical RILD was recorded. This study concluded that high-dose PBT is associated with high rates of LC and OS for unresectable HCC. Dose escalation may further improve outcomes.