A Prospective Phase 2 Multicenter Study for the Efficacy of Radiation Therapy Following Incomplete Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma

Choi, Cha-Yong; Koom, Woong Sub; Kim, Tae Hyun; Yoon, Sang Min; Kim, Jin Hee; Lee, Hyung Sik; Nam, Taek Keun; Seong, Jinsil

doi:10.1016/j.ijrobp.2014.08.011

Cited by 34 publications

(29 citation statements)

References 35 publications

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“…Of note, CP A cirrhosis was also associated with an improved prognosis compared with CP B disease, but 88 patients (22.1%) with CP B cirrhosis successfully underwent treatment without significant toxicity. Finally, a prospective Phase II trial of 31 patients with HCC who received salvage 3D-CRT after TACE (no more than three courses) demonstrated impressive infield (radiotherapy target volume) rates of overall response, complete response and partial response rates of 83.9, 22.6 and 61.3% [85]. These series demonstrated both the safety and value of radiotherapy as a salvage treatment modality after TACE.…”

Section: Outcomes Of Modern Liver-directed Radiotherapymentioning

confidence: 85%

Radiotherapy for liver tumors

Keane

Tanguturi

Dawson³

et al. 2015

Hepat. Oncol.

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Many patients with primary hepatic malignancies present with advanced disease that is not suitable for surgical resection, orthotopic liver transplantation, or radiofrequency ablation. Outcomes are particularly dismal in patients with large, unresectable tumors and/or tumor venous thrombosis. Liver-directed radiotherapy, including stereotactic body radiotherapy (SBRT), is able to treat a variety of tumor sizes and tumors with venous involvement and has demonstrated excellent safety and control outcomes. SBRT should be considered a standard option in patients with early-stage hepatocellular carcinoma who are not candidates for surgical resection, orthotopic liver transplantation or radiofrequency ablation. SBRT should be strongly considered in patients with larger tumors and/or tumors with tumor venous thrombosis who have adequate liver function. Radiotherapy should remain a focus of hepatocellular carcinoma research.

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Section: Outcomes Of Modern Liver-directed Radiotherapymentioning

confidence: 85%

Radiotherapy for liver tumors

Keane

Tanguturi

Dawson³

et al. 2015

Hepat. Oncol.

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“…This cohort included 88 patients with Child-Pugh (CP) B cirrhosis. Salvage RT after TACE has also demonstrated impressive rates of local control, with an overall response rate (ORR) of 83.9% and a complete response rate of 22.6% [66].…”

Section: Overviewmentioning

confidence: 99%

Liver-Directed Radiotherapy for Hepatocellular Carcinoma

Keane

Hong

2016

Liver Cancer

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Background: The incidence of hepatocellular carcinoma (HCC) continues to increase world-wide. Many patients present with advanced disease with extensive local tumor or vascular invasion and are not candidates for traditionally curative therapies such as orthotopic liver transplantation (OLT) or resection. Radiotherapy (RT) was historically limited by its inability to deliver a tumoricidal dose; however, modern RT techniques have prompted renewed interest in the use of liver-directed RT to treat patients with primary hepatic malignancies. Summary: The aim of this review was to discuss the use of external beam RT in the treatment of HCC, with particular focus on the use of stereotactic body radiotherapy (SBRT). We review the intricacies of SBRT treatment planning and delivery. Liver-directed RT involves accurate target identification, precise and reproducible patient immobilization, and assessment of target and organ motion. We also summarize the published data on liver-directed RT, and demonstrate that it is associated with excellent local control and survival rates, particularly in patients who are not candidates for OLT or resection. Key Messages: Modern liver-directed RT is safe and effective for the treatment of HCC, particularly in patients who are not candidates for OLT or resection. Liver-directed RT, including SBRT, depends on accurate target identification, precise and reproducible patient immobilization, and assessment of target and organ motion. Further prospective studies are needed to fully delineate the role of liver-directed RT in the treatment of HCC.

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“…A meta-analysis demonstrated that TACE in combination with RT significantly improves the 5 year-survival (odds ratio [OR]: 4.47, 95% confidence interval [CI]: 2.08-9.61, p=0.0001) and tumor CR (OR: 2.58, 95% CI: 1.64-4.06, p=0.0001) rates compared to TACE alone [50]. A recent prospective phase II multicenter study investigated the efficacy and toxicity of RT following an incomplete response to TACE [51]; 31 patients who still had viable tumors after no more than three courses of TACE were enrolled, whereas patients with main PV invasion were excluded. The primary endpoint was tumor response.…”

Section: Additional Rt After Incomplete Response To Tace or Rt For Hcmentioning

confidence: 99%

“…With 3D-CRT or IMRT, total doses of 21-60 Gy/1.8-5 Gy per fraction have been reported [18,47,49,51,59,64,65,67,77].…”

Section: Published Dose Fractionation For Each Rt Techniquementioning

confidence: 99%

Optimal Selection of Radiotherapy as Part of a Multimodal Approach for Hepatocellular Carcinoma

Yoon¹,

Seong²

2016

Liver Cancer

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A multimodal approach to treatment is a basic oncologic principle with proven survival benefits for most cancer types. However, existing guidelines recommend single modalities for treating each stage of hepatocellular carcinoma (HCC). Nonetheless, multimodal approaches can be considered for HCC, depending on the characteristics of the disease in individual cases. Radiotherapy (RT), an effective local modality, is a critical element of most multimodal approaches. Improved RTtechnology and increased understanding of the tolerance of the liver to radiation have contributed to the popularity of RT for treating liver tumors in clinical practice. Consequently, numerous reports have described the effects of RT on liver cancer, despite a lack of stringent evidence for its benefits. RT can be delivered using various technologies and approaches, which may be the source of some confusion. For example, high-dose ablative RT can be curative on its own, or high-dose ablative or conventional RT can complement other treatments such as radiofrequency ablation and transarterial chemoembolization. Combinations of systemic agents and RT can also be applied. This review discusses the optimal selection of RT as part of a multimodal approach for HCC.

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A Prospective Phase 2 Multicenter Study for the Efficacy of Radiation Therapy Following Incomplete Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma

Cited by 34 publications

References 35 publications

Radiotherapy for liver tumors

Radiotherapy for liver tumors

Liver-Directed Radiotherapy for Hepatocellular Carcinoma

Optimal Selection of Radiotherapy as Part of a Multimodal Approach for Hepatocellular Carcinoma

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