Treatment Plan for Stage II Liver Cancer

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  • Treatment Plan for Stage I Liver Cancer – Proton Beam Therapy (PBT) Approach

1. Initial Consulltation & Evaluation

Comprehensive assessment by:
Radiation oncologist
Hepatobiliiary surgeon
Medical oncologist
Evaluation of tumor size, location, and liver function to determine eligibility for curative-intent proton beam therapy.
Discussion of treatment options, expected outcomes, and potential side effects

2. Medical Records Review & Pre-Treatment Assessment

Review of prior imaging, pathology reports, and medical history.
Assessment of liver function using Child-Pugh score and ALBI score.
Determination of performance status (ECOG/KPS) to assess patient fitness for treatment.

3. Laboratory Investigations

Complete blood count (CBC)
liiver function tests (LFTs)
Renal function panel
Coagulation profile
Tumor markers (Alpha-Fetoprotein – AFP)
Hepatitis B and C serology (if applicable)

4. Pre-Treatment Imaging

Multiphasic contrast-enhanced CT or MRI of the liver to define tumor margins and assess local involvement.
PET-CT (if indicated) to rulle out extrahepatic disease.
Simulation CT scan (4D-CT) for proton therapy planning, accounting for respiratory motion.

5. Multidisciplinary Tumor Board Discussion

Case evaluation by a team including radiation oncologists, hepatobiliary surgeons, and interventional radiologists.
Decision on treatment strategy:
Definitive proton therapy as an alternative to surgery for inoperable patients.
Adjuvant proton therapy if small residual tumor remains after resection.

6. Treatment Planning & Preparation

Patient positioning and immobilization with a customized mold to minimize movement.
Respiratory motion management, including breath-hold technique or respiratory gating.
Proton therapy dose planning
Standard regimen: 67.5 Gy in 15 fractions (hypofractionated approach).
Alternative regimen: 50–58 Gy in 5 fractions (for select cases with well-compensated liver function).
Dosimetric evaluation to ensure high-dose delivery to the tumor while minimizing exposure to healthy liver tissue.

7. Proton Therapy Sessions

Outpatient treatment schedule: Sessions administered 5 days per week for 3–4 weeks.
Each session lasts 20–30 minutes, with proton delivery taking a few minutes
Pre-treatment imaging (CBCT or X-ray) before each session to verify positioning and tumor targeting.

8. Management of Side Effects

Common side effects
Mild fatigue
Nausea or mild GI discomfort
Temporary elevation of liiver enzymes
Rare but serious compliications:
Radiation-induced liver disease (RILD) (monitored via LFTs).
Regular follow-ups with supportive care as needed.

9. Post-Treatment Monitoring & Follow-Up

First post-treatment imaging (CT/MRI) at 1–2 months to assess tumor response.
AFP monitoring (if initially elevated) for recurrence detection.
Liver function tests every 4–6 weeks post-treatment to evaluate liver tolerance.
Long-term surveillance with imaging every 3–6 months to monitor for recurrence.

10. Next Steps & Additional Considerations

Surgical reassessment if tumor downsizing is observed and patient becomes eligible for resection.
Systemic therapy consideration (e.g., immunotherapy or targeted therapy) if progression occurs.
Potential liver transplantation evaluation in selected cases.

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Melbourne, Australia
(Sat - Thursday)
(10am - 05 pm)
Contact us
Melbourne, Australia
(Sat - Thursday)
(10am - 05 pm)
Contact us

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