Liver stereotactic radiotherapy (SRT) with functional treatment planning for patients with intermediate stage hepatocellular carcinoma (HCC)

Kudithipudi, V.; Day, E.; Thai, Ngoc; Kirichenko, Alexander

doi:10.1007/s13566-017-0325-4

Cited by 6 publications

(7 citation statements)

References 21 publications

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“…22 High-precision SBRT for unresectable HCCs sustained local control rates consistently over 90% in varying degrees of cirrhosis with minimal risk of radiation induced liver disease. [23][24][25][26][27] SBRT has also demonstrated tumor downsizing rates of over 70% with pathologic complete response of approximately 30-50%, comparable to the 59% downstaging rate (39% pathologic complete response) observed in this analysis. 7,12,24,28 In a recent study by Uemura et al, 50% of treated HCCs showed either complete or near-complete pathologic response.…”

Section: Discussionsupporting

confidence: 73%

“…Early liver SBRT studies reported a higher risk of RILD in Child Pugh B patients, however more recent publications with stricter dose constraints and sophisticated treatment planning suggest otherwise. 25,27,29 For instance, Kirichenko and colleagues published a series of HCC SBRT studies with SPECT-based functional treatment planning that resulted in no instances of classic or non-classic RILD for Child Pugh B, and even select (i.e. strictly bridge-to-transplant) Child Pugh C patients.…”

Section: Discussionmentioning

confidence: 99%

“…strictly bridge-to-transplant) Child Pugh C patients. 25,30 Weighing the potential benefit of bridging RT in HCC against the potential post-transplant morbidity and mortality is of paramount importance to establish safety before its inclusion in treatment guidelines. There are limited data regarding the effects of liver-directed RT on hepatic surgery and associated complications.…”

Section: Discussionmentioning

confidence: 99%

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Liver transplant mortality and morbidity following preoperative radiotherapy for hepatocellular carcinoma

Hasan

Abel

Uemura

et al. 2020

HPB

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Background: Radiotherapy (RT) can be used for tumor downstaging and as a bridge to transplantation in hepatocellular carcinoma (HCC), but its effect on surgical complications is unknown. Therefore, we investigated post-transplant mortality and acute readmission rates in HCC with and without preoperative RT using the National Cancer Database (NCDB).Methods: After exclusion, 11,091 transplant patients were analyzed, 165 of whom received RT prior to transplant. Multivariable binomial logistic regression analysis identified characteristics associated with use of RT, and factors associated with increased 30/90-day mortality and 30-day readmission, following propensity matching.Results: Although RT (median 40 Gy in 5 fractions) was more often delivered to larger tumors and advanced stages, it resulted in 59% downstaging rate, 39% pathologic complete response rate, and a median of 4 additional months to transplantation. Crude 30/90-day mortality rates were both 1.2% with preoperative RT, compared to 2.7% and 4.4% without. The 30-day readmission rate was 5.5% with RT and 10.7% without it. Propensity matched analysis demonstrated no statistical differences in 30/90-day mortality and a lower 30-day readmission rate with preoperative RT. Age >58, stage III disease, lack of transarterial chemoembolization, and shorter time to transplant independently predicted higher 90-day mortality. Conclusion:Preoperative RT for HCC did not increase postoperative mortality or length of stay following liver transplant.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Liver transplant mortality and morbidity following preoperative radiotherapy for hepatocellular carcinoma

Hasan

Abel

Uemura

et al. 2020

HPB

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“…Twenty-seven of them were excluded because they were case reports, number of patients less than five, had no available information or had already included the latest or most informative publication of the same research team . Finally, the remaining twenty articles met the meta-analysis or descriptive tables (3,5,6,9,10,(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55).…”

Section: Resultsmentioning

confidence: 99%

“…Although the endpoints used to evaluate RILD were inconsistent across studies. Seven studies evaluated RILT after functional liver-sparing planning-guided radiotherapy, six of which were prospective and one retrospective (6,44,48,(51)(52)(53)55) (Table 2B). A total of 180 patients were included, 111 had a baseline CTP score A, and the rest had score B or higher (55 patients), and one publication did not describe baseline liver function.…”

Section: Resultsmentioning

confidence: 99%

Functional Liver Imaging in Radiotherapy for Liver Cancer: A Systematic Review and Meta-Analysis

Zhou

Zhang

et al. 2022

Front. Oncol.

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BackgroundsFunctional liver imaging can identify functional liver distribution heterogeneity and integrate it into radiotherapy planning. The feasibility and clinical benefit of functional liver-sparing radiotherapy planning are currently unknown.MethodsA comprehensive search of several primary databases was performed to identify studies that met the inclusion criteria. The primary objective of this study was to evaluate the dosimetric and clinical benefits of functional liver-sparing planning radiotherapy. Secondary objectives were to assess the ability of functional imaging to predict the risk of radiation-induced liver toxicity (RILT), and the dose-response relationship after radiotherapy.ResultsA total of 20 publications were enrolled in descriptive tables and meta-analysis. The meta-analysis found that mean functional liver dose (f-MLD) was reduced by 1.0 Gy [95%CI: (-0.13, 2.13)], standard mean differences (SMD) of functional liver volume receiving ≥20 Gy (fV20) decreased by 0.25 [95%CI: (-0.14, 0.65)] when planning was optimized to sparing functional liver (P >0.05). Seven clinical prospective studies reported functional liver-sparing planning-guided radiotherapy leads to a low incidence of RILD, and the single rate meta-analysis showed that the RILD (defined as CTP score increase ≥2) incidence was 0.04 [95%CI: (0.00, 0.11), P <0.05]. Four studies showed that functional liver imaging had a higher value to predict RILT than conventional anatomical CT. Four studies established dose-response relationships in functional liver imaging after radiotherapy.ConclusionAlthough functional imaging modalities and definitions are heterogeneous between studies, but incorporation into radiotherapy procedures for liver cancer patients may provide clinical benefits. Further validation in randomized clinical trials will be required in the future.

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The albumin-bilirubin (ALBI) model in hepatocellular carcinoma (HCC) may better predict hepatic failure in patients with traditionally low-risk cirrhosis following definitive stereotactic body radiotherapy (SBRT)

et al. 2018

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Liver stereotactic radiotherapy (SRT) with functional treatment planning for patients with intermediate stage hepatocellular carcinoma (HCC)

Cited by 6 publications

References 21 publications

Liver transplant mortality and morbidity following preoperative radiotherapy for hepatocellular carcinoma

Liver transplant mortality and morbidity following preoperative radiotherapy for hepatocellular carcinoma

Functional Liver Imaging in Radiotherapy for Liver Cancer: A Systematic Review and Meta-Analysis

The albumin-bilirubin (ALBI) model in hepatocellular carcinoma (HCC) may better predict hepatic failure in patients with traditionally low-risk cirrhosis following definitive stereotactic body radiotherapy (SBRT)

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