Radiation Segmentectomy: Potential Curative Therapy for Early Hepatocellular Carcinoma

Abstract

Purpose:To report long-term outcomes of radiation segmentectomy (RS) for early hepatocellular carcinoma (HCC). The authors hypothesized that outcomes are comparable to curative treatments for patients with solitary HCC less than or equal to 5 cm and preserved liver function. Materials and Methods:This retrospective study included 70 patients (median age, 71 years; range, 22-96 years) with solitary HCC less than or equal to 5 cm not amenable to percutaneous ablation who underwent RS (dose of .190 Gy) between 2003 and. Patients who underwent subsequent curative liver transplantation were excluded to eliminate this confounding variable affecting survival. Radiologic response of time to progression and median overall survival were estimated by using the Kaplan-Meier method per the guidelines of the European Association for the Study of the Liver (EASL) and the World Health Organization (WHO). Results:Seventy patients were treated with RS over 14 years. Sixty-three patients (90%) showed response by using EASL criteria, of which 41 (59%) showed complete response. Fifty patients (71%) achieved response by using WHO criteria, of which 11 (16%) achieved complete response. Response rates at 6 months were 86% and 49% by using EASL and WHO criteria, respectively. Median time to progression was 2.4 years (95% confidence interval: 2.1, 5.7), with 72% of patients having no target lesion progression at 5 years. Median overall survival was 6.7 years (95% confidence interval: 3.1, 6.7); survival probability at 1, 3, and 5 years was 98%, 66%, and 57%, respectively. Overall survival probability at 1, 3, and 5 years was 100%, 82%, and 75%, respectively, in patients with baseline tumor size less than or equal to 3 cm (n = 45) and was significantly longer than in patients with tumors greater than 3 cm (P = .026). In our study, we review our longterm outcomes (.10 years) of patients with HCC less than or equal to 5 cm not amenable to resection, radiofrequency ablation, or transplantation who underwent RS. We hypothesize that this approach could be considered potentially curative based on the same rationale as resection, radiofrequency ablation, and transplantation. Conclusion Materials and MethodsR.J.L. and R.S. are advisors to BTG International. There was no funding for this analysis and all authors had control of the data and information submitted for publication. Our study was approved by the institutional review board and was compliant with the Health Insurance Portability and Accountability Act. All patients provided written informed consent prior to receiving treatment after selecting RS over chemoembolization. We searched our prospectively acquired database of HCC (10) for patients treated with 90 Y radioembolization from December 2003 to 2016 (14 years). Inclusion criteria were as follows: solitary HCC less than or equal to 5 cm, preserved liver function (Child-Pugh class A), and no vascular invasion or extrahepatic metastases (7). Patients who underwent transplantation or resection were excluded to mitigate the potential confo...

Laparoscopic access to the liver and application of laparoscopic microwave ablation in 2 dogs with liver neoplasia

“…Advanced therapies have recently become standard in human surgery for nonresectable hepatic tumors and can be applied via a laparoscopic approach. For example, clinical efficacy of embolization, radiation segmentectomy with yittrium‐90, and microwave ablation (MWA) has been demonstrated in humans with nonresectable hepatic neoplasia …”

Locoregional Therapy for Hepatocellular Carcinoma: Transarterial Chemoembolization Versus Transarterial Radioembolization Versus Stereotactic Body Radiotherapy†

“…Among those who subsequently underwent resection after RS, a tumor dose greater than 190 Gy was associated with a higher rate of complete pathological necrosis. Recently, a median OS of CP A patients with a single lesion smaller than 5 cm was 6.7 years, offering results comparable with curative intent, including LT, resection, and RFA . Retrospective analysis with propensity matching in patients with a single lesion less than 3 cm who were treated with RS versus TACE + microwave ablation reported similar TTP, response rates, and OS .…”

Liver Resection Combined with Radiotherapy versus Liver Resection Alone in the Treatment of Hepatocellular Carcinoma: A Population-based Study

“…A recent study by Lewandowski and collaborators concluded that radiotherapy could extend the survival of patients with early HCC. The results indicated that 90% of patients showed tumor response according to the EASL criteria, of which 59% showed a complete response with a median time to progression of 2.4 years and mOS of 6.7 years [24]. Another analysis utilizing PSM compared the e cacy of radiotherapy and RFA in HCC patients with no more than three tumors, 3 cm or smaller in size.…”