Recent clinical applications of external beam radiotherapy for hepatocellular carcinoma according to guidelines, major trials and meta‐analyses

Rim, Chai Hong; Yim, Hyung Joon; Park, Sunmin; Seong, Jinsil

doi:10.1111/1754-9485.12948

Cited by 17 publications

(10 citation statements)

References 51 publications

(111 reference statements)

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“…[ 6 ] EBRT is much less affected by tumor location and tumor size than radiofrequency ablation, and has a higher local control (LC) rate than TACE. [ 7 ] It can be applied to tumors ≥ 5 cm in size and achieve 74% of 1-year LC. [ 8 ] Previous studies have confirmed the safety and feasibility of radiotherapy alone in elderly and super-elderly patients with cancer.…”

Section: Discussionmentioning

confidence: 99%

External beam radiation therapy in a centenarian with primary liver cancer

et al. 2020

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Rationale: Due to unprecedented global aging, the number of elderly and super-elderly patients with cancer is increasing. However, restricted by comorbidities or fragility, many elderly patients are considered ineligible to receive invasive therapies. A centenarian with primary liver cancer (PLC) was treated by external beam radiation therapy (EBRT). This rare case deserves our attention. Patient concerns: We present a rare case of a centenarian with PLC. The super-elderly male patient complained that 2 liver lesions were found by abdominal ultrasonography in June 2016. Diagnoses: The Segment 7 (S7) lesion and the Segment 5/8 (S5/8) lesion were clinically diagnosed as PLC successively. Interventions: The S7 lesion was considered PLC initially and treated by EBRT in October 2016. In the 1-year follow-up after EBRT, the S7 lesion was well controlled. Unfortunately, the S5/8 lesion had increased in size, was diagnosed as PLC and subsequently treated by CyberKnife in another hospital. However, local failure of the S5/8 lesion was suggested 15 months after CyberKnife. At the age of 102 years, the patient received re-irradiation for the S5/8 lesion. Outcomes: Three months after re-irradiation, des-γ-carboxy-prothrombin decreased to normal; no significant change in the S5/8 lesion was found in Magnetic Resonance Imaging. No severe acute or late toxicities were reported after each course of EBRT. Unfortunately, the patient died of respiratory failure caused by severe pneumonia in mid-March 2020. Conclusion: Advanced age is not a contraindication for elderly patients with cancer to receive radiotherapy and even re-irradiation.

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Section: Discussionmentioning

confidence: 99%

External beam radiation therapy in a centenarian with primary liver cancer

et al. 2020

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“…Subgroup comparisons were performed using mixed effects analyses and Cochran’s Q-test, based on analysis of variance. Subgroup analyses were performed to examine local treatment methods (surgery vs. EBRT) as well as known clinical prognosticators including CPC-A, accompanying PVT, and extrahepatic metastases [17, 30]. Borderline values between subgroups were set close to the overall median value.…”

Section: Methodsmentioning

confidence: 99%

Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta-analysis

Lee

Park

Seo

et al. 2020

Preprint

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Purpose: As the treatment efficacy of systemic therapy for patients with advanced stage HCC is insufficient, locoregional therapies are performed in the clinical practice. We investigated the efficacy and safety of two most potent therapies, surgery and external beam radiotherapy (EBRT), in patients with HCC involving the IVC and/or right atrium (RA) through comparative meta-analysis. Method: A systematic search of Pubmed, MEDLINE, EMBASE, and the Cochrane library was performed for entries up to July 2020. The primary endpoints were 1 and 2 year overall survival (OS) rates, while secondary endpoints were response rate, local control rate, and grade >=3 toxicities. Results: Eighteen studies with 22 cohorts were included, encompassing 755 patients. The pooled median OS and 1 and 2 year OS rates were 14.2 months, 55.6%, and 27.4%, respectively. The pooled median OS in the surgery and EBRT arms were 15.3 and 11.7 months, respectively. The pooled 1 year OS rate of the surgery arm was significantly higher than that of the EBRT arm (62.4%, 95% CI: 53.8–70.3 vs. 48.8%, 95% CI: 40.9–56.8; p=0.023). However, the 2 year OS rates were comparable (26.9%, 95% CI: 20.7–34.2 vs. 27.5%, 95% CI: 19.7–37.1; p=0.913). The pooled response and local control rates in the EBRT arm were 74.3% and 87.2%, respectively. In the surgical arm, the perioperative mortality and grade >=3 complication rates were 0–7.6% and 3.9–67%, respectively. Grade >=3 complications and radiation induced liver disease were rarely observed in the EBRT arm. Conclusions: Both surgery and EBRT are effective treatment options for patients with HCC involving IVC/RA invasion. Outcomes and safety should be further evaluated in well-controlled clinical trials.

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“…External beam radiotherapy (EBRT) has recently emerged as a treatment for HCC and has several advantages. Modern EBRT with computed tomography planning can encompass large tumors with a homogeneous dose distribution [ 11 , 12 ]. The response rates of EBRT range from 50% to 80%, even for tumors with major vessel invasion [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Salvage External Beam Radiotherapy after Incomplete Transarterial Chemoembolization for Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review

et al. 2021

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Background and objective: Although transarterial chemoembolization (TACE) has been the commonest local modality for hepatocellular carcinoma (HCC), incomplete repsonse occurs especially for tumors with a large size or difficult tumor accessment. The present meta-analysis assessed the efficacy and feasibility of external beam radiotherapy (EBRT) as a salvage modality after incomplete TACE. Materials and Methods: We systematically searched the PubMed, Embase, Medline, and Cochrane databases. The primary endpoint was overall survival (OS), and the secondary endpoints included the response ratem toxicity of grade 3, and local control. Results: Twelve studies involving 757 patients were included; the median of portal vein thrombosis rate was 25%, and the pooled median of tumor size was 5.8 cm. The median prescribed dose ranged from 37.3 to 150 Gy (pooled median: 54 Gy in *EQD2). The pooled one- and two-year OS rates were 72.3% (95% confidence interval (CI): 60.2–81.9%) and 50.5% (95% CI: 35.6–65.4%), respectively; the pooled response and local control rates were 72.2% (95% CI: 65.4–78.1%) and 86.6 (95% CI: 80.1–91.2%) respectively. The pooled rates of grade ≥3 gastrointestinal toxicity, radiation-induced liver disease, hepatotoxicity, and hematotoxicity were 4.1%, 3.5%, 5.7%, and 4.9%, respectively. Local control was not correlated with intrahepatic (p = 0.6341) or extrahepatic recurrences (p = 0.8529) on meta-regression analyses. Conclusion: EBRT was feasible and efficient in regard to tumor response and control; after incomplete TACE. Out-field recurrence, despite favorable local control, necessitates the combination of EBRT with systemic treatments. *Equivalent dose in 2 Gy per fraction scheme.

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Recent clinical applications of external beam radiotherapy for hepatocellular carcinoma according to guidelines, major trials and meta‐analyses

Cited by 17 publications

References 51 publications

External beam radiation therapy in a centenarian with primary liver cancer

External beam radiation therapy in a centenarian with primary liver cancer

Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta-analysis

Salvage External Beam Radiotherapy after Incomplete Transarterial Chemoembolization for Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review

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