In Regard to Sanford et  al

To the Editor: We would like to congratulate Sanford et  al on their comparison of proton versus photon treatment in 133 patients with hepatocellular carcinoma (HCC).1 Nonrandomized comparisons of patients with HCC are challenging because survival rates are affected by etiology of liver disease and baseline liver function. We note that 59% of proton pat ients had well-compensated liver function (Child-Pugh A5) versus 36% of photon patients. After accounting for imbalances in a multivariable analysis, differences in clinically relevant endpoints (nonclassic radiation-induced liver toxicity and overall survival) persisted in favor of protons, providi ng a compelling case for protons, particularly in patients with large HCCs where the low-dose splash from photons may increase the risk of liver toxicity.
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Comment Source Type: research