This study aims to review the current evidence on the utility of stereotactic body radiation therapy (SBRT), with or without transarterial chemoembolization (TACE), for early-stage hepatocellular carcinoma (ESHCC) patients not amenable to standard curative treatment options. MethodsLiterature search was conducted using PubMed, ScienceDirect, and Google Scholar. Comparative studies reporting oncologic outcomes were included in the review. ResultsFour studies (one prospective cohort, three retrospective studies) compared SBRT versus TACE. Pooled analysis showed an overall survival (OS) bene t after three years (OR 1.67, 95% CI 1.17-2.39, p = 0.005) which persisted in the 5-year data (OR 1.53, 95% CI 1.06-2.39, p = 0.02) in favor of SBRT. Recurrence-free survival bene t with SBRT was also seen at three years (OR 2.06, 95% CI 1.03-4.11, p = 0.04) which continued after ve years (OR 2.35, 95% CI 1.47-3.75, p = 0.0004). Two retrospective studies compared TACE followed by SBRT (TACE + SBRT) versus TACE alone. Pooled analysis showed signi cantly improved 3year OS (OR 5.47;, p < 0.0001) and local control (LC) (OR: 21.05; 95% CI 5.01-88.39, p = < 0.0001) in favor of the TACE + SBRT group. A phase III study showed signi cantly improved LC and progression-free survival with SBRT after failed TACE/TAE versus further TACE/TAE.
Purpose To report technical details and 15-month outcomes of a patient with node-positive external auditory canal (EAC) squamous cell carcinoma (SCC) treated with definitive intracavitary high-dose-rate (HDR) brachytherapy to primary tumor, and external beam radiotherapy (EBRT) to draining lymphatics. Material and methods A 21-year-old male was diagnosed with SCC of the right EAC. The patient underwent definitive HDR intracavitary brachytherapy, 340 cGy/fraction for 14 twice-daily fractions, followed by EBRT using intensity-modulated radiation therapy (IMRT) to cover the grossly enlarged pre-auricular node, ipsilateral intra-parotid, and cervical lymph node levels II and III. Results The approved brachytherapy plan had an average high-risk clinical tumor volume (CTV-HR) D 90 of 341 cGy with a total dose of 47.7 Gy (BED, 80.3 Gy, EQD 2 , 66.6 Gy). For the approved IMRT plan, the prescription to the involved right pre-auricular node was 66 Gy in 33 fractions, and more than 95% of the target received at least 62.7 Gy. High-risk nodal regions were simultaneously prescribed: 59.4 Gy in 1.8 Gy fractions, and more than 95% received at least 56.4 Gy. Organs at risk (OARs) were kept below their dose constraints. The patient tolerated both the procedures with no grade ≥ 2 treatment-related adverse events. Grade 1 dermatitis in the right pre-auricular and cervical areas during the course of EBRT was experienced. Fifteen months post-RT, the patient has no evidence of disease, and was noted to have EAC stenosis, which translated to moderate conductive hearing loss of the right ear. Thyroid function was normal at 15 months after EBRT. Conclusions This case report illustrates that the delivered definitive radiotherapy is technically feasible, effective, and well-tolerated in patients with SCC of EAC.
Purpose This study aims to review the current evidence on the utility of stereotactic body radiation therapy (SBRT), with or without transarterial chemoembolization (TACE), for early-stage hepatocellular carcinoma (ESHCC) patients not amenable to standard curative treatment options. Methods Literature search was conducted using PubMed, ScienceDirect, and Google Scholar. Comparative studies reporting oncologic outcomes were included in the review. Results Four studies (one prospective cohort, three retrospective studies) compared SBRT versus TACE. Pooled analysis showed an overall survival (OS) benefit after three years (OR 1.67, 95% CI 1.17–2.39, p = 0.005) which persisted in the 5-year data (OR 1.53, 95% CI 1.06–2.39, p = 0.02) in favor of SBRT. Recurrence-free survival benefit with SBRT was also seen at three years (OR 2.06, 95% CI 1.03–4.11, p = 0.04) which continued after five years (OR 2.35, 95% CI 1.47–3.75, p = 0.0004). Two retrospective studies compared TACE followed by SBRT (TACE + SBRT) versus TACE alone. Pooled analysis showed significantly improved 3-year OS (OR 5.47; 95% CI 2.47–12.11, p < 0.0001) and local control (LC) (OR: 21.05; 95% CI 5.01–88.39, p = < 0.0001) in favor of the TACE + SBRT group. A phase III study showed significantly improved LC and progression-free survival with SBRT after failed TACE/TAE versus further TACE/TAE. Conclusions In ESHCC patients not amenable to established SOC, SBRT alone or the combination of TACE + SBRT appears to be more effective than TACE alone. SBRT after TACE/TAE failure also appears to be superior to further TACE/TAE based on a phase III trial. Larger prospective studies are warranted to further define the role of SBRT and TACE for ESHCC.
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