Background Stereotactic body radiation therapy (SBRT) is an emerging option for unresectable hepatocellular carcinoma (HCC) without consensus regarding optimal dose schemas. This analysis identifies practice patterns and factors that influence dose selection and overall survival, with particular emphasis on dose and tumor size. Materials/Methods Query of the National Cancer Database (NCDB) identified patients with unresectable, nonmetastatic HCC who received SBRT from 2004 to 2013. Biological Effective Dose (BED) was calculated for each patient in order to uniformly analyze different fractionation regimens. Results A total of 456 patients met the inclusion criteria. The median BED was 100 Gy (22.5‐208.0), which corresponded to the most common dose fractionation (50 Gy in five fractions). Various factors influenced dose selection including tumor size (P < 0.001), tumor stage (P = 0.002), and facility case volume (<0.001). On multivariate analysis, low BED (<75 Gy, HR 2.537, P < 0.001; 75‐100 Gy, HR 1.986, P = 0.007), increasing tumor size (HR 1.067, P = 0.032), elevated AFP (HR 1.585, P = 0.019), stage 3 (HR 1.962, P < 0.001), low‐volume facilities (1‐5 cases HR 1.687, P = 0.006), and a longer time interval from diagnosis to SBRT (>2 to ≤4 months, HR 1.456, P = 0.048; >4 months, HR 2.192, P < 0.001) were associated with worse survival. Conclusion SBRT use is increasing for HCC, and multiple regimens are clinically employed. Although high BED was associated with improved outcomes, multiple factors contributed to the dose selection with favorable patients receiving higher doses. Continued efforts to enhance radiation planning and delivery may help improve utilization, safety, and efficacy.

Stroke survivors often experience upper extremity deficits that make activities of daily living (ADLs) like dressing, cooking and bathing difficult or impossible. Survivors experience paresis, the inability to efficiently and fully activate muscles, which combined with decreased use of the upper extremity, will lead to muscle atrophy and potentially an increase in intramuscular fat. Muscle atrophy has been linked to weakness post stroke and is an important contributor to upper extremity deficits. However, the extent of upper extremity atrophy post hemiparetic stroke is unknown and a better understanding of these changes is needed to inform the direction of intervention-based research. In this study, the volume of contractile tissue and intramuscular fat in the elbow and wrist flexors and extensors were quantified in the paretic and non-paretic upper limb using MRI and the Dixon technique for the first time. Total muscle volume (p≤0.0005) and contractile element volume (p≤0.0005) were significantly smaller in the paretic upper extremity, for all muscle groups studied. The average percent difference between limbs and across participants was 21.3% for muscle volume and 22.9% for contractile element volume. We also found that while the percent intramuscular fat was greater in the paretic limb compared to the nonparetic (p≤0.0005), however, the volume of intramuscular fat was not significantly different between upper limbs (p=0.231). The average volumes of intramuscular fat for the elbow flexors/extensors and wrist flexors/extensors were 28.1, 28.8 and 19.9, 8.8 cm 3 in the paretic limb and 29. 6, 27.7 and 19.7, 8.8 cm 3 in the non-paretic limb. In short, these findings indicate a decrease in muscle volume and not an increase in intramuscular fat, which will contribute to the reduction in strength in the paretic upper limb.

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Background: Palliative radiation therapy (RT) for bone metastases (BMs) is a common practice. Wide variation exists in clinically used dose schema despite numerous studies demonstrating palliative equipoise between single and multifraction courses. We hypothesize that fraction scheme for palliating BMs for hepatocellular carcinoma (HCC) significantly affects how patients spend their remaining time.Methods: Patients with osseous HCC metastases who received RT were identified from the National Cancer Database (2004Database ( -2013. The percentage of remaining life spent receiving radiation therapy (PRLSRT) and the number of incomplete RT courses were calculated. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate trends and predictors.Results: A total of 1,331 patients met the inclusion criteria. Median overall survival (OS) was 3.3 months.Just 49 (3.7%) of patients received single fraction RT and 34% received >10 fractions. The mean and median PRLSRT were as follows: 1 fraction (8.9% and 3.0%), 2-5 fractions (32.9% and 24.3%), 6-10 fractions (27.2% and 15.9%), and >10 fractions (24.1% and 14.4%). Of the patients with PRLSRT >50%, 99.6% received multifraction RT. The proportion of incomplete RT courses increased as fraction size decreased from 17.6% with 4 Gy to 34% with 2 Gy.Conclusions: Single fraction palliative RT is vastly underutilized despite no additional palliative benefit with multifraction RT. PRLSRT significantly increased with multifraction RT. In the palliative treatment of painful BMs from HCC, single fraction treatment reduces time spent receiving radiation treatments and maximizes the number of patients who complete the prescribed treatment.