Role of Stereotactic Body Radiation Therapy Before Orthotopic Liver Transplantation: Retrospective Evaluation of Pathologic Response and Outcomes

Mannina, Edward M.; Cárdenes, Higinia R.; Lasley, Foster D.; Goodman, Benjamin D.; Zook, Jennifer; Althouse, Sandra K.; Cox, John A.; Saxena, Romil; Tector, Joseph; Maluccio, Mary A.

doi:10.1016/j.ijrobp.2016.12.036

Cited by 43 publications

(43 citation statements)

References 26 publications

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“…This study demonstrated that 40% of patients with CR had persistent tumor arterial hyperenhancement, 90% had persistent washout, but no patient had tumor size increases. Mannina et al 68 retrospectively evaluated 38 patients with HCC (CP-A 45%) treated with SBRT prior to orthotopic liver transplantation (OLT) and demonstrated poor concordance of pathologic gold standard, defined as CR + PR, to radiologic scoring criteria of mRECIST (sensitivity 90%, specificity 17%), RECIST (sensitivity 54%, specificity 50%), and EASL (sensitivity 83%, specificity 18%); however, no patient was incorrectly categorized as having disease progression. An older report with an imaging–pathology correlation by Facciuto et al showed response assessment by RECIST v1.1 criteria significantly correlated with pathologic CR seen in 14% of patients and that radiologic response peaked at 3 months.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Current Trends and Controversies

Schaub

Hartvigson

Lock

et al. 2018

Technol Cancer Res Treat

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Hepatocellular carcinoma is the fourth leading cause of cancer-related death worldwide. Depending on the extent of disease and competing comorbidities for mortality, multiple liver-directed therapy options exist for the treatment of hepatocellular carcinoma. Advancements in radiation oncology have led to the emergence of stereotactic body radiation therapy as a promising liver-directed therapy, which delivers high doses of radiation with a steep dose gradient to maximize local tumor control and minimize radiation-induced treatment toxicity. In this study, we review the current clinical data as well as the unresolved issues and controversies regarding stereotactic body radiation therapy for hepatocellular carcinoma: (1) Is there a radiation dose–response relationship with hepatocellular carcinoma? (2) What are the optimal dosimetric predictors of radiation-induced liver disease, and do they differ for patients with varying liver function? (3) How do we assess treatment response on imaging? (4) How does stereotactic body radiation therapy compare to other liver-directed therapy modalities, including proton beam therapy? Based on the current literature discussed, this review highlights future possible research and clinical directions.

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Section: Introductionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Current Trends and Controversies

Schaub

Hartvigson

Lock

et al. 2018

Technol Cancer Res Treat

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“…That study also indicated that radiographic response criteria (discussed below) had poor concordance with pCR. 75 Another study investigated HIGRT, radioembolization, RFA, or TACE as a bridge to liver transplantation in 60 patients. Grade 3 toxicity was noted in 6 patients who received TACE or RFA (there was no grade 3 toxicity in the HIGRT or radioembolization groups); pCR was noted in 29% with HIGRT, in 41% with TACE, in 60% with RFA, in 75% with radioembolization, and in 33% of patients who received multiple modalities.…”

Section: Rt As a Bridge To Transplantationmentioning

confidence: 99%

The role of external beam radiotherapy in the treatment of hepatocellular cancer

Chino

Stephens

Marin

et al. 2018

Cancer

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Hepatocellular carcinoma (HCC) is increasing in incidence and mortality. Although the prognosis remains poor, long-term survival has improved from 3% in 1970 to an 18% 5-year survival rate today. This is likely because of the introduction of well tolerated, oral antiviral therapies for hepatitis C. Curative options for patients with HCC are often limited by underlying liver dysfunction/cirrhosis and medical comorbidities. Less than one-third of patients are candidates for surgery, which is the current gold standard for cure. Nonsurgical treatments include embolotherapies, percutaneous ablation, and ablative radiation. Technological advances in radiation delivery in the past several decades now allow for safe and effective ablative doses to the liver. Conformal techniques allow for both dose escalation to target volumes and normal tissue sparing. Multiple retrospective and prospective studies have demonstrated that hypofractionated image-guided radiation therapy, used as monotherapy or in combination with other liver-directed therapies, can provide excellent local control that is cost effective. Therefore, as the HCC treatment paradigm continues to evolve, ablative radiation treatment has moved from a palliative treatment to both a "bridge to transplant" and a definitive treatment.

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“…Radiographic local control rates exceed 85% (►Table 1). [84][85][86][87][88][89] In studies assessing for radiographic response only a few months after SBRT, response rates may be lower 90 but are likely underestimations as SBRT response can take up to 6 months or longer. 91 Pathologic response rates were variable, ranging from 37 to 70%.…”

Section: Bridge Therapy and Downstagingmentioning

confidence: 99%

“…91 Pathologic response rates were variable, ranging from 37 to 70%. [87][88][89][90]92,93 Although not a prospective study, Princess Margaret Hospital in Canada recently reported a comparison of 36 patients treated with SBRT to 99 patients treated with TACE and 244 patients treated with RFA. 93 Using a median dose of 36 Gy in six fractions, the investigators found that SBRT resulted in complete tumor necrosis in 13% of patients, compared with 24% in TACE and 49% in RFA-treated patients.…”

Section: Bridge Therapy and Downstagingmentioning

confidence: 99%

“…Compared with other liver-directed therapies, SBRT was associated with lower toxicity and decreased hospitalization days 96 but tended to cause more liver function impairment. 93 Surgical complication rates were not increased in patients receiving SBRT as bridge therapy, 85,86,88,93 although one study identified a single patient for whom a modification of surgical approach was needed. 84 Few reports are dedicated to describing the efficacy of SBRT in downstaging patients to become eligible for transplant.…”

Section: Bridge Therapy and Downstagingmentioning

confidence: 99%

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Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

Feng

2018

Semin Liver Dis

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Hepatocellular carcinoma (HCC) is a complex and diverse disease, with choice of treatment dependent on a patient's disease burden, location of disease, underlying liver function, and performance status. While radiation therapy (RT) was historically omitted from treatment algorithms, immense technological advances over the past several decades have enabled introduction of RT as an effective and safe treatment option for patients with HCC. Growing prospective and retrospective evidence supports the use of RT, particularly stereotactic body radiotherapy (SBRT), for a wide range of indications in HCC from locally advanced unresectable disease to bridge therapy for liver transplant candidates. SBRT is associated with excellent local control, even for patients refractory to or ineligible for other forms of locoregional therapy. Treatment is well-tolerated and associated with low rates of severe toxicity. Randomized trials are needed to define the role of SBRT in HCC treatment relative to other established locoregional treatments.

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Role of Stereotactic Body Radiation Therapy Before Orthotopic Liver Transplantation: Retrospective Evaluation of Pathologic Response and Outcomes

Cited by 43 publications

References 26 publications

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Current Trends and Controversies

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Current Trends and Controversies

The role of external beam radiotherapy in the treatment of hepatocellular cancer

Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

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