肝细胞癌 (HCC) 是癌症相关死亡的主要原因，外照射放射治疗已成为治疗 HCC 的一种有前景的方法。质子束治疗 (PBT) 比 X 射线治疗具有剂量测定优势，具有被称为布拉格峰的卓越物理特性。 PBT 有望降低肝毒性并允许安全地增加肿瘤剂量。它已在各种临床条件下进行了尝试，并显示出有希望的局部肿瘤控制和生存结果。最近的一项 III 期试验证明，与当前标准射频消融治疗早期 HCC 相比，PBT 在局部肿瘤控制方面并不逊色。与中期经动脉化疗栓塞相比，PBT 也往往显示出更有利的结果，并且已证明对晚期 HCC 具有有效的现场疾病控制和安全的毒性特征。在这篇综述中，我们讨论了 PBT 在 HCC 治疗中的基本原理、临床研究、最佳适应症和未来方向。

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, and external beam radiation therapy has emerged as a promising approach for managing HCC. Proton beam therapy (PBT) offers dosimetric advantages over X-ray therapy, with superior physical properties known as the Bragg peak. PBT holds promise for reducing hepatotoxicity and allowing safe dose-escalation to the tumor. It has been tried in various clinical conditions and has shown promising local tumor control and survival outcomes. A recent phase III trial demonstrated the non-inferiority of PBT in local tumor control compared to current standard radiofrequency ablation in early-stage HCC. PBT also tended to show more favorable outcomes compared to transarterial chemoembolization in the intermediate stage, and has proven effective in-field disease control and safe toxicity profiles in advanced HCC. In this review, we discuss the rationale, clinical studies, optimal indication, and future directions of PBT in HCC treatment.