A Multi-Institutional Retrospective Study of Repeated Stereotactic Body Radiation Therapy for Intrahepatic Recurrent Hepatocellular Carcinoma

Kimura, Tomoki; Takeda, Atsuya; Tsurugai, Yuichiro; Kawano, Reo; Doi, Yoshiko; Oku, Yohei; Hioki, Kazunari; Miura, Hideharu; Nagata, Yasushi

doi:10.1016/j.ijrobp.2020.07.034

Cited by 25 publications

(19 citation statements)

References 25 publications

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“…They reported that the median maximum dose of combined initial and secondary SBRT to the normal liver (Liver-PTV) in patients with in-field recurrence was 359 Gy (EQD 2 , α/β = 2); however, no adverse events related to liver tolerance were observed in these patients, except for mild ascites controlled with diuretics. Kimura et al reported reirradiation with SBRT for out-of-field recurrence of HCC [19]. They reported that the median mean dose of each SBRT to the normal liver (Liver-GTV) was 13.3 Gy, and only biochemical and hematologic toxicities were observed.…”

Section: Discussionmentioning

confidence: 99%

Long-term survivor of hepatocellular carcinoma treated with repeated carbon ion radiotherapy and transarterial chemoembolization: a case report

Ohtaka

Shiba

Shibuya

et al. 2022

Clin J Gastroenterol

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Hepatocellular carcinoma (HCC) often recurs in the liver and requires multiple rounds of treatment. Thus, less-invasive multidisciplinary approaches are essential for preserving liver function, especially in elderly patients. Here, we report a case of an 86 year-old Japanese male patient with HCC who was successfully treated with repeated carbon ion radiotherapy (C-ion RT) and transarterial chemoembolization (TACE). The patient had alcoholic liver cirrhosis with a 60 mm HCC lesion and a satellite lesion in segment 6. The patient underwent initial C-ion RT but developed primary tumor recurrence (segment 6) and a new lesion (segment 2) 24 months later. The patient received TACE for each lesion, followed by an increased dose of C-ion RT for the recurrent primary tumor. Although the primary tumor lesion was well controlled, the patient subsequently developed new lesions, and TACE was repeated. The patient died of bacterial pneumonia 88 months after the initial treatment. His general condition and liver function were well preserved, and no severe adverse events were observed throughout the course of treatment. These results suggest that a less-invasive multidisciplinary approach involving repeated C-ion RT combined with TACE enables preservation of liver function, which may contribute to long-term survival in elderly patients with HCC.

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Section: Discussionmentioning

confidence: 99%

Long-term survivor of hepatocellular carcinoma treated with repeated carbon ion radiotherapy and transarterial chemoembolization: a case report

Ohtaka

Shiba

Shibuya

et al. 2022

Clin J Gastroenterol

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“…In regards to this issue, some retrospective studies published in recent years have reported that repeated SBRT for recurrent HCC was safely performed with acceptable hepatic toxicity. [41][42][43] In order to clarify long-term liver toxicities of both treatments, prospective studies in larger numbers of patients are necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, RFA is safely repeated for intrahepatic recurrences and often applied to recurrent HCC in clinical practice, whereas the feasibility of repeated SBRT for recurrent HCC had been unclear. In regards to this issue, some retrospective studies published in recent years have reported that repeated SBRT for recurrent HCC was safely performed with acceptable hepatic toxicity 41–43 . In order to clarify long‐term liver toxicities of both treatments, prospective studies in larger numbers of patients are necessary.…”

Section: Discussionmentioning

confidence: 99%

Comparison of stereotactic body radiotherapy and radiofrequency ablation for hepatocellular carcinoma: Systematic review and meta‐analysis of propensity score studies

Eriguchi

Takeda

Tateishi

et al. 2021

Hepatology Research

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Aim: Stereotactic body radiotherapy (SBRT) is an emerging treatment for hepatocellular carcinoma (HCC) and has shown excellent local control (LC), as has radiofrequency ablation (RFA). As no randomized controlled trial has compared SBRT and RFA for HCC, data from a propensity score matched study (PSMS) are valuable.However, the results varied greatly and depended on composing factors of Barcelona Clinic Liver Cancer staging (BCLC-factors) adjusted. Therefore, we undertook a systematic review and meta-analyses of the studies focusing on BCLC-factors matching. Methods:We systematically searched PubMed, the Cochrane database, EMBASE, and Web of Science to identify studies comparing RFA and SBRT using propensity scores. The hazard ratios (HRs) of overall survival (OS) and LC from BCLC-factormatched and -unmatched PSMS were pooled. Heterogeneity between the data from these studies was assessed.Results: Three BCLC-factor-matched studies were identified. Stereotactic body radiotherapy led to comparable OS (HR, 0.89; 95% CI, 0.74-1.08; p = 0.24; I 2 = 0%; p for heterogeneity, 0.56) and significantly better LC (HR, 0.39; 95% CI, 0.30-0.51; p < 0.001; I 2 = 0%; p for heterogeneity, 0.67). We also identified three additional BCLC-factor-unmatched studies (HR of OS, 1.41; 95% CI, 1.21-1.65; p < 0.0001; I 2 = 0%; p for heterogeneity, 0.63). However, considerable heterogeneity was observed for HR of OS between BCLC-factor-matched and -unmatched studies (I 2 = 92.6%; p for heterogeneity, 0.0002). Conclusions:When BCLC-factors were properly adjusted, the results of the metaanalysis revealed equivalent OS and better LC for SBRT compared with RFA. Stereotactic body radiotherapy could be an alternative treatment option for HCC.

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“…SBRT could also be considered a substitute therapy to surgery or RFA in this situation. Kimura et al reported the results of repeated SBRT in 81 patients with 189 tumors of two courses or more (median two times; ranged from two to four times) [ 47 ]. The 5 year local recurrence rate, OS and liver-related death rates from the first SBRT were 6.3%, 60.4% and 32.9%, respectively.…”

Section: Sbrt In Early-stage Hccmentioning

confidence: 99%

The Current Role of Stereotactic Body Radiation Therapy (SBRT) in Hepatocellular Carcinoma (HCC)

Kimura

Fujiwara

Kameoka

et al. 2022

Cancers

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The role of stereotactic body radiotherapy (SBRT), which can deliver high radiation doses to focal tumors, has greatly increased in not only early-stage hepatocellular carcinoma (HCC), but also in portal vein or inferior vena cava thrombi, thus expanding this therapy to pre-transplantation and the treatment of oligometastases from HCC in combination with immune checkpoint inhibitors (ICI). In early-stage HCC, many promising prospective results of SBRT have been reported, although SBRT is not usually indicated as a first treatment potion in localized HCC according to several guidelines. In the treatment of portal vein or inferior vena cava tumor thrombi, several reports using various dose-fraction schedules have shown relatively good response rates with low toxicities and improved survival due to the rapid advancements in systemic therapy. Although SBRT is regarded as a substitute therapy when conventional bridging therapies to transplantation, such as transarterial chemoembolization (TACE) and radiofrequency ablation (RFA), are not applicable or fail in controlling tumors, SBRT may offer advantages in patients with borderline liver function who may not tolerate TACE or RFA, according to several reports. For oligometastases, the combination of SBRT with ICI could potentially induce an abscopal effect in patients with HCC, which is expected to provide the rationale for SBRT in the treatment of oligometastatic disease in the near future.

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A Multi-Institutional Retrospective Study of Repeated Stereotactic Body Radiation Therapy for Intrahepatic Recurrent Hepatocellular Carcinoma

Cited by 25 publications

References 25 publications

Long-term survivor of hepatocellular carcinoma treated with repeated carbon ion radiotherapy and transarterial chemoembolization: a case report

Long-term survivor of hepatocellular carcinoma treated with repeated carbon ion radiotherapy and transarterial chemoembolization: a case report

Comparison of stereotactic body radiotherapy and radiofrequency ablation for hepatocellular carcinoma: Systematic review and meta‐analysis of propensity score studies

The Current Role of Stereotactic Body Radiation Therapy (SBRT) in Hepatocellular Carcinoma (HCC)

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