Phase 2 study of stereotactic body radiotherapy and optional transarterial chemoembolization for solitary hepatocellular carcinoma not amenable to resection and radiofrequency ablation

Abstract

BACKGROUND: Curative treatment options for patients with early stage hepatocellular carcinoma (HCC) include resection, liver transplantation, and percutaneous ablation therapy. However, even patients with solitary HCC are not always amenable to these treatments. The authors prospectively investigated the clinical outcomes of patients who received stereotactic body radiotherapy (SBRT) for solitary HCC. METHODS: A phase 2 study involving SBRT and optional transarterial chemoembolization (TACE) was conducted in patients with Child-Pugh grade A or B and underlying, solitary HCC (greatest tumor dimension, 4 cm) who were unsuitable candidates for resection and radiofrequency ablation. The prescription dose was 35 to 40 grays in 5 fractions. The primary endpoint was 3-year local tumor control. RESULTS: From 2007 to 2012, 101 patients were enrolled, and 90 were evaluable with a median follow-up of 41.7 months (range, 6.8-96.2 months). Thirty-two patients were treatment-na€ ıve, 20 were treated for newly diagnosed intrahepatic failure, and 38 were treated for residual or recurrent HCC as salvage therapy. Thirty-two patients did not receive TACE, 48 received insufficient TACE, and 10 attained full lipiodol accumulation. The 3-year local control rate was 96.3%, the 3-year liver-related causespecific survival rate was 72.5%, and the overall survival rate was 66.7%. Grade 3 laboratory abnormalities were observed in 6 patients, and 8 patients had Child-Pugh scores that worsened by 2 points. CONCLUSIONS: SBRT achieved high local control and overall survival with feasible toxicities for patients with solitary HCC, despite rather stringent conditions. SBRT can be effective against solitary HCC in treatment-naive, intrahepatic failure, residual disease, and recurrent settings, taking advantage of its distinctive characteristics. Cancer 2016;122:2041-9. V C 2016 American Cancer Society. KEYWORDS: curative treatment, hepatocellular carcinoma (HCC), noninvasive treatment, stereotactic body radiotherapy (SBRT). INTRODUCTIONCurative treatment options for patients with early stage hepatocellular carcinoma (HCC) are resection, liver transplantation (LT), and percutaneous ablation therapy. 1 However, <30% of patients are eligible for these treatments. 2 In addition, patients with solitary HCC are not always suitable for these treatments, 3 presumably because of poor liver function and/or tumor location. In such situations, the patient usually received transarterial chemoembolization (TACE) 1 ; however, local control after TACE is unsatisfactory. 4,5 Stereotactic body radiotherapy (SBRT) is a high-precision, conformal, external-beam radiation technique that ablates the target at extracranial sites using hypofractionated, high-dose radiation while sparing surrounding normal tissues. Currently, SBRT is considered a treatment option for patients with medically inoperable, early stage, nonsmall cell lung cancer. 6 Findings from retrospective series of patients with small HCC who received SBRT indicated high local control rates from 99% to 100...

Lycorine Promotes Autophagy and Apoptosis via TCRP1/Akt/mTOR Axis Inactivation in Human Hepatocellular Carcinoma

“…HepG2 Cells (5 Â 10 6 in 0.2-mL PBS) were inoculated (via subcutaneous injection) into 7-week-old BALB/c female athymic nude mice (Taconic). When tumor volumes reached 100 mm 3 , mice were randomized into 3 groups (n ¼ 8/group) and received intraperitoneal injection with lycorine (10 or 20 mg/kg/d) or vehicle every other day for 33 days. Tumor volume and body weight were monitored every 3 days.…”

“…HCC is a heterogeneous disease originated from chronic liver diseases, such as chronic inflammation and cirrhosis. To date, the therapeutic strategy against HCC is mainly composed of resection, transplantation, local ablation, and chemotherapy (3,4). Because early symptoms of HCC are not obvious, most patients with HCC are diagnosed at advanced stages and are unsuitable for potentially curative therapies such as resection, transplantation, and local ablation (5)(6)(7).…”

The advantage of iron-containing fiducial markers placed with a thin needle for radiotherapy of liver cancer in terms of visualization on MRI: an initial experience of Gold Anchor

“…reported that the 3-year local control rate of liver cancer was 96.3%, the 3-year liver-related cause-specific survival rate was 72.5%, the overall survival rate was 66.7%, and toxicity was tolerable [9]. The use of SABR is expected to increase as this method advances in the future.…”

External beam radiotherapy for unresectable hepatocellular carcinoma, an international multicenter phase I trial, SAKK 77/07 and SASL 26

“…For tumors ≥2 cm, there was decreased FFLP for RFA compared with SBRT (HR, 3.35; p = 0.025). Takeda et al [44] conducted a phase II study, treating 90 CP A and B score patients with a solitary HCC lesion up to a diameter of 4 cm, unsuitable for resection and RF with SBRT and optional TACE. Three-year LC rate and OS was 96.3% and 66.7% (95% CI, 56.3–75.6%) respectively.…”