Hafiz Fahrurrozi, Andang Widi Harto, Isman Mulyadi Triatmoko, Gede Sutrisna Wijaya, Yohannes Sardjono



Liver cancer was the third leading cause of death from cancer in 2020 with 830,180 deaths worldwide. Radiotherapy is a common treatment method for liver cancer. Technological advances presented proton therapy and boron neutron capture therapy (BNCT) as alternatives with a lower dose on healthy organs. The objective of this research is to get a good dose distribution with higher tumor dose and lower healthy organ dose in proton therapy. A comparison with BNCT is done to get a better understanding of how both methods deliver the dose to treat the cancer while minimizing healthy organ doses. The research simulated proton therapy for cancer liver with Particle and Heavy Ions Transport Code System (PHITS), and a literature review for BNCT. The effectiveness of both methods were compared by tumor dose and liver dose. The optimal tumor dose for proton therapy is 86.01 Gy (W) with 0.67 Gy (W) liver dose. Proton therapy can replace conventional radiotherapy for tumors with complex shapes in dose delivery by utilizing its dose profile, while BNCT can give better tumor control on patients previously treated with conventional radiotherapy.

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  1. Ferlay J., Ervik M., Lam F., Colombet M., Mery L., Piñeros M., et al. Global Cancer Observatory: Cancer Today. Lyon, France:International Agency for Research on Cancer; 2020.
  2. Ahmad M.S., Suardi N., Mustapa A.S., Mohammad H., Oglat A.A., Bassam M. Current Status Regarding the Tumour Of HCC : A Literature Review. J. Gastroenterol. Hepatol. Res. 2019. 8(2):2841-2852.
  3. Fukumitsu N., Okumura T., Sakurai H. Radiotherapy for Liver Cancer. J. Gen. Fam. Med. 2017. 18(3):126-130.
  4. Reig M., da Fonseca L.G., Faivre S. New Trials and Results in Systemic Treatment of HCC. J. Hepatol. 2018. 69(2):525-533.
  5. Chadha A.S., Gunther J.R., Hsieh C.E., Aliru M., Mahadevan L.S., Venkatesulu B.P., et al. Proton Beam Therapy Outcomes for Localized Unresectable Hepatocellular Carcinoma. Radiother. Oncol. 2019. 133:54-61.
  6. Chuong M., Kaiser A., Molitoris J., Romero A.M., Apisarnthanarax S. Proton Beam Therapy for Liver Cancers. J. Gastrointest. Oncol. 2020. 11(1):157-165.
  7. Mondlane G., Ureba A., Gubanski M., Lind P.A., Siegbahn A. Estimation of the Risk for Radiation-induced Liver Disease Following Photon- or Proton-beam Radiosurgery of Liver Metastases. Radiat. Oncol. 2018. 13(206):1-9
  8. Badiyan S.N., Hallemeier C.L., Lin S.H., Hall M.D., Chuong M.D. Proton Beam Therapy for Gastrointestinal Cancers: Past, Present, and Future. J. Gastrointest. Oncol. 2018. 9(5):962-971.
  9. Wiyanti W. Pertama di Asia Tenggara, RI Akan Punya Proton Beam Therapy untuk Kanker [Accessed: 20 October 2020]. Availablefrom:
  10. Ahmadi Ganjeh Z., Eslami-Kalantari M., Mowlavi A.A. Dosimetry Calculations of Involved and Noninvolved Organs in Proton Therapy of Liver Cancer: a Simulation Study. Nucl. Sci. Tech. 2019. 30(12):1-7.
  11. Mohan R., Grosshans D. Proton Therapy - Present and Future. Adv. Drug Deliv. Rev. 2017. 109:26-44.
  12. Kim D.H., Cho S., Jo K., Shin E.H., Hong C.S., Han Y., et al. Proton Range Verification in Inhomogeneous Tissue: Treatment Planning System vs. Measurement vs. Monte Carlo Simulation. PLoS One. 2018. 13(3):1-14.
  13. Igaki H., Mizumoto M., Okumura T., Hasegawa K., Kokudo N., Sakurai H. A Systematic Review of Publications on Charged Particle Therapy for Hepatocellular Carcinoma. Int. J. Clin. Oncol. 2018. 23(3):423-433.
  14. Oshiro Y., Mizumoto M., Okumura T., Fukuda K., Fukumitsu N., Abei M., et al. Analysis of Repeated Proton Beam Therapy for Patients with Hepatocellular Carcinoma. Radiother. Oncol. 2017. 123(2):240-245.
  15. Newhauser W.D., Zhang R. The Physics of Proton Therapy. Phys. Med. Biol. 2015. 60(8):155-209.
  16. Leroy R., Benahmed N., Hulstaert F., Mambourg F., Fairon N., Van Eycken E., et al. Hadron Therapy in Children – an Update of the Scientific Evidence for 15 Paediatric Cancers. 2015.
  17. Barth R.F., Mi P., Yang W. Boron Delivery Agents for Neutron Capture Therapy of Cancer. Cancer Commun. 2018. 38(1):1-15.
  18. Barth R.F., Zhang Z., Liu T. A Realistic Appraisal of Boron Neutron Capture Therapy as a Cancer Treatment Modality. Cancer Commun. London, England. 2018. 38(36):1-7.
  19. Hung Y.H., Lin Y.C., Lin Y.T., Shih G.W., Liao J.W., Chen K.S., et al. Therapeutic Efficacy and Radiobiological Effects of Boric Acid-mediated BNCT in a VX2 Multifocal Liver Tumor-bearing Rabbit Model. Anticancer Res. 2019. 39(10):5495-5504.
  20. Nedunchezhian K., Aswath N., Thiruppathy M., Thirugnanamurthy S. Boron Neutron Capture Therapy - a Literature Review. J. Clin. Diagnostic Res. 2016. 10(12):1-4.
  21. Olusanya T.O.B., Calabrese G., Fatouros D.G., Tsibouklis J., Smith J.R. Liposome Formulations of O-carborane for the Boron Neutron Capture Therapy of Cancer. Biophys. Chem. 2019. 247:25-33.
  22. Wu C.Y., Lin J.J., Chang W.Y., Hsieh C.Y., Wu C.C., Chen H. Sen, et al. Development of Theranostic Active-targeting Boron-Containing Gold Nanoparticles for Boron Neutron Capture Therapy (BNCT). Colloids Surfaces B Biointerfaces. 2019. 183:110387.
  23. Garabalino M.A., Olaiz N., Portu A., Saint Martin G., Thorp S.I., Pozzi E.C.C., et al. Electroporation Optimizes the Uptake of Boron-10 by Tumor for Boron Neutron Capture Therapy (BNCT) Mediated by GB-10: a Boron Biodistribution Study in the Hamster Cheek Pouch Oral Cancer Model. Radiat. Environ. Biophys. 2019. 58(3):455-467.
  24. Provenzano L., Koivunoro H., Postuma I., Longhino J.M., Boggio E.F., Farías R.O., et al. The Essential Role of Radiobiological Figures of Merit for the Assessment and Comparison of Beam Performances in Boron Neutron Capture Therapy. Phys. Medica. 2019. 67:9-19.
  25. Marshall T.I., Chaudhary P., Michaelidesová A., Vachelová J., Davídková M., Vondráček V., et al. Investigating the Implications of a Variable RBE on Proton Dose Fractionation Across a Clinical Pencil Beam Scanned Spread-Out Bragg Peak. Int. J. Radiat. Oncol. Biol. Phys. 2016. 95(1):70-77.
  26. Mizumoto M., Okumura T., Hashimoto T., Fukuda K., Oshiro Y., Fukumitsu N., et al. Proton Beam Therapy for Hepatocellular Carcinoma: A Comparison of Three Treatment Protocols. Int. J. Radiat. Oncol. Biol. Phys. 2011. 81(4):1039-1045.
  27. Sato T., Iwamoto Y., Hashimoto S., Ogawa T., Furuta T., Abe S. ichiro, et al. Features of Particle and Heavy Ion Transport ode System (PHITS) version 3.02. J. Nucl. Sci. Technol. 2018. 55(6):684-690.
  28. Henrotin S., Abs M., Forton E., Jongen Y., Kleeven W., Verbruggen P., et al. Commissioning and Testing of the First IBA S2C2. in: Proc. 21st Int. Conf. on Cyclotrons and Their Applications (Cyclotrons - 16). 2016. 178-180.
  29. Mohan R., Peeler C.R., Guan F., Bronk L., Cao W., Grosshans D.R. Radiobiological Issues in Proton Therapy. Acta Oncol. Madr. 2017. 56(11):1367-1373.
  30. Chen Y., Grassberger C., Li J., Hong T.S., Paganetti H. Impact of Potentially Variable RBE in Liver Proton Therapy. Phys. Med. Biol. 2018. 63(19):1-30
  31. Jaschke W., Schmuth M., Trianni A., Bartal G. Radiation-Induced Skin Injuries to Patients: What the Interventional Radiologist Needs to Know. Cardiovasc. Intervent. Radiol. 2017. 40(8):1131-1140.
  32. Emami B. Tolerance of Normal Tissue to Therapeutic Irradiation. Reports of Radiotherapy and Oncology. 2013. 1(1):35-48
  33. Ahmadi Ganjeh Z., Eslami-Kalantari M. Design and Optimization of Two-sided Beam Based on7Li(p,n)7Be Source using in BNCT for Brain and Liver Tumors. Nucl. Instruments Methods Phys. Res. Sect. A Accel. Spectrometers, Detect. Assoc. Equip. 2019. 916:290-295.
  34. Yanagie H., Higashi S., Seguchi K., Ikushima I., Fujihara M., Nonaka Y., et al. Pilot Clinical Study of Boron Neutron Capture Therapy for Recurrent Hepatic Cancer Involving the Intra-arterial Injection of a 10BSH-containing WOW Emulsion. Appl. Radiat. Isot. 2014. 88:32-37.
  35. Suzuki M. Boron Neutron Capture Therapy (BNCT): a Unique Role in Radiotherapy with a View to Entering the Accelerator-Based BNCT era. Int. J. Clin. Oncol. 2020. 25(1):43-50.
  36. Chuong M.D., Kaiser A., Khan F., Parikh P., Ben-Josef E., Crane C., et al. Consensus Report from the Miami Liver Proton Therapy Conference. Front. Oncol. 2019. 9:1-6.


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