۲- Materials and Methods

۳- Results

۴- Discussion

۵- Conclusions

References

Introduction

Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver [1]. According to the NCCN guidelines, there are numerous strategies for treating HCC, including resection, transplantation, radiofrequency ablation, transarterial chemoembolization (TACE), radiotherapy (RT), and systemic therapy using sorafenib or lenvatinib [2]. All patients with HCC should be evaluated for potential curative therapies, including resection and transplantation [2]. Locoregional therapy, including ablation, TACE, and RT, is indicated for patients who are not candidates for curative therapy or indicated as a bridge therapy for patients who are candidates for transplantation [2]. Recent reports have described favorable clinical outcomes afer proton beam therapy (PBT) for HCC, based on a 5- year overall survival rate of 24–۴۸% [۳, ۴] and a 5-year local control rate of approximately 80% [3, 5]. Among the external beam RT modalities, PBT may be superior to X-ray therapy based on excellent dose localization to the therapeutic target [1]. Furthermore, given the good outcomes afer PBT for HCC, some patients may be eligible for TACE treatment of intrahepatic HCC metastasis, while repeated PBT, TACE, or systemic therapy may be feasible in cases of local recurrence afer PBT. Moreover, PBT is efective for patients with HCC who also have portal vein tumor thrombus (PVTT) [6], and the efcacy of combined therapy of TACE and RT for HCC with PVTT has been reported [7, 8]. Terefore, given the growing interest in using PBT for HCC, it is possible that TACE could be used for selected patients who have previously undergone PBT. Te purpose of our study is to evaluate the angiographic fndings from patients with HCC previously treated using PBT.