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The escalated relative biological effectiveness\u2010weighted dose levels included 55, 60, 65, and 70\u2009Gy in 10 fractions. Active motion management techniques were employed, and several measures were applied to mitigate the interplay effect induced by a moving target. CIRT was planned with the LEM\u2010I\u2010based treatment planning system and delivered by raster scanning. Offline PET\/CT imaging was used to verify the beam range. Offline adaptive replanning was performed whenever required. Twenty\u2010three patients with a median tumor size of 4.3\u00a0cm (range, 1.7\u20138.5\u00a0cm) were enrolled in the present study. The median follow\u2010up time was 56.1\u00a0months (range, 5.7\u201374.4\u00a0months). No dose limiting toxicity was observed until 70\u2009Gy, and MTD had not been reached. No patients experienced radiation\u2010induced liver disease within 6\u00a0months after the completion of CIRT. The overall survival rates at 1, 3, and 5\u2009years were 91.3%, 81.9%, and 67.1% after CIRT, respectively. The local progression\u2010free survival and progression\u2010free survival rates at 1, 3 and 5\u2009years were 100%, 94.4%, and 94.4% and 73.6%, 59.2%, and 37.0%, respectively. The raster scanning technique could be used to treat HCC. However, caution should be exercised to mitigate the interplay effect. CIRT up to 70\u2009Gy in 10 fractions over 2\u2009weeks was safe and effective for HCC.<\/jats:p>","DOI":"10.1111\/cas.15633","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T06:46:35Z","timestamp":1667198795000},"page":"976-983","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Carbon ion radiotherapy with pencil beam scanning for hepatocellular carcinoma: Long\u2010term outcomes from a phase I trial"],"prefix":"10.1111","volume":"114","author":[{"given":"Zhengshan","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Shanghai Proton and Heavy Ion Center  Shanghai China"},{"name":"Shanghai Key Laboratory of Radiation Oncology (20dz2261000)  Shanghai China"},{"name":"Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy  Shanghai 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