{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:02:31Z","timestamp":1790632951981,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T00:00:00Z","timestamp":1647993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004606","name":"Chang Gung Medical Foundation","doi-asserted-by":"publisher","award":["CMRPG3J0341"],"award-info":[{"award-number":["CMRPG3J0341"]}],"id":[{"id":"10.13039\/501100004606","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004606","name":"Chang Gung Medical Foundation","doi-asserted-by":"publisher","award":["CMRPG3J0342"],"award-info":[{"award-number":["CMRPG3J0342"]}],"id":[{"id":"10.13039\/501100004606","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004606","name":"Chang Gung Medical Foundation","doi-asserted-by":"publisher","award":["CMRPG3J0343"],"award-info":[{"award-number":["CMRPG3J0343"]}],"id":[{"id":"10.13039\/501100004606","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Hepatocellular carcinoma (HCC) with bile duct invasion is a rare and notorious subtype of HCC. This study included patients that had unresectable HCC with bile duct invasion and proton beam therapy between November 2015 and February 2021. Twenty patients fit the inclusion criteria. The median tumor size was 6.3 cm. Nine patients (45.0%) had major vascular invasions. All included patients received the radiation dose of 72.6 gray relative biological effectiveness due to the proximity of porta hepatis and tumor. The median follow-up time was 19.9 months. The median overall survival was 19.9 months among deceased patients. The 1-year cumulative local recurrence rates were 5.3%, with only two patients developing in-field failure. The 1-year and 2-year overall survival rates were 79.4% and 53.3%. The 1-year progression-free survival was 58.9%. Four patients developed radiation-induced liver disease. The 1-year cholangitis-free survival was 55.0%. Skin toxicity was the most common acute toxicity and rarely severe. Eight patients developed \u2264 grade 3 gastrointestinal ulcers. Proton beam therapy offers desirable survival outcomes for unresectable HCC patients with bile duct invasion. Optimal local tumor control could also be obtained within acceptable toxicities.<\/jats:p>","DOI":"10.3390\/cancers14071616","type":"journal-article","created":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T12:20:25Z","timestamp":1648038025000},"page":"1616","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Proton Beam Therapy in Managing Unresectable Hepatocellular Carcinoma with Bile Duct Invasion"],"prefix":"10.3390","volume":"14","author":[{"given":"Ching-Hsin","family":"Lee","sequence":"first","affiliation":[{"name":"Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An-Hsin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Ping","family":"Hung","sequence":"additional","affiliation":[{"name":"Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-En","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"},{"name":"Cancer Biology and Immunology Programs, Graduate School of Biomedical Sciences, University of Texas MD Anderson UTHealth, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeng-Hwei","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1085-5259","authenticated-orcid":false,"given":"Po-Jui","family":"Chen","sequence":"additional","affiliation":[{"name":"Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5080-0394","authenticated-orcid":false,"given":"Jen-Yu","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph Tung-Chieh","family":"Chang","sequence":"additional","affiliation":[{"name":"Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-0113","authenticated-orcid":false,"given":"Kun-Ming","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi-Ming","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Chun","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Ting","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei City 100225, Taiwan"},{"name":"Cancer Research Center, National Taiwan University College of Medicine, Taipei City 100225, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0477-448X","authenticated-orcid":false,"given":"Bing-Shen","family":"Huang","sequence":"additional","affiliation":[{"name":"Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and University, Taoyuan City 333423, Taiwan"},{"name":"Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan"},{"name":"Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan City 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,23]]},"reference":[{"key":"ref_1","unstructured":"European Association for the Study of the Liver (2018). 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