Safety and Efficacy of Accelerated Hypofractionation and Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma Patients With Varying Degrees of Hepatic Impairment

Nabavizadeh, Nima; Waller, Joseph; Fain, Robert; Chen, Yiyi; Degnin, Catherine; Elliott, David A.; Mullins, Brandon T.; Patel, Ishan; Dyer, Brandon A.; Fakhoury, Kareem; Naugler, Willscott E.; Farsad, Khashayar; Tanyi, James A.; Fuß, Martin; Thomas, Charles R.; Hung, Arthur

doi:10.1016/j.ijrobp.2017.11.030

Cited by 36 publications

(33 citation statements)

References 21 publications

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“…Six patients developed late onset, grade 4-5 toxicities that were attributed to damage to the proximal bronchial tree, ergo highlighting the need for caution when employing hypofractionated regimes. Hypofractionation is nevertheless getting more widely used in the clinic for a variety of treatments sites (59,(61)(62)(63)(64), and could be proven even more useful together with FLASH-RT and its (potentially) lower level of normal tissue toxicity.…”

Section: Clinical Applications Of Flash-rtmentioning

confidence: 99%

Ultra-High Dose Rate (FLASH) Radiotherapy: Silver Bullet or Fool's Gold?

et al. 2020

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Radiotherapy is a cornerstone of both curative and palliative cancer care. However, radiotherapy is severely limited by radiation-induced toxicities. If these toxicities could be reduced, a greater dose of radiation could be given therefore facilitating a better tumor response. Initial pre-clinical studies have shown that irradiation at dose rates far exceeding those currently used in clinical contexts reduce radiation-induced toxicities whilst maintaining an equivalent tumor response. This is known as the FLASH effect. To date, a single patient has been subjected to FLASH radiotherapy for the treatment of subcutaneous T-cell lymphoma resulting in complete response and minimal toxicities. The mechanism responsible for reduced tissue toxicity following FLASH radiotherapy is yet to be elucidated, but the most prominent hypothesis so far proposed is that acute oxygen depletion occurs within the irradiated tissue. This review examines the tissue response to FLASH radiotherapy, critically evaluates the evidence supporting hypotheses surrounding the biological basis of the FLASH effect, and considers the potential for FLASH radiotherapy to be translated into clinical contexts.

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Section: Clinical Applications Of Flash-rtmentioning

confidence: 99%

Ultra-High Dose Rate (FLASH) Radiotherapy: Silver Bullet or Fool's Gold?

et al. 2020

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“…Despite the studies documenting good postresection outcomes for carefully selected HCC with PVTT, the suitability of the procedure for such patients remains controversial . The extensive application of precision radiotherapy technologies, such as 3D‐CRT, IMRT, and SBRT, has rendered greatly improved role of radiotherapy in the comprehensive treatment of HCC. Plenty of studies have indicated that the median survival time in HCC with PVTT treated by radiotherapy ranges from 8.6 to 44.7 months .…”

Section: Discussionmentioning

confidence: 99%

“…The extensive application of precision radiotherapy technologies, such as 3D‐CRT, IMRT, and SBRT, has rendered greatly improved role of radiotherapy in the comprehensive treatment of HCC. Plenty of studies have indicated that the median survival time in HCC with PVTT treated by radiotherapy ranges from 8.6 to 44.7 months . Radiotherapy can be employed in unresectable locally advanced HCC patients with no extrahepatic metastasis, those of grade A/B in Child‐Pugh Ratings, and those with the tumor volume being less than 2/3 of normal liver volume.…”

Section: Discussionmentioning

confidence: 99%

“…Plenty of studies have indicated that the median survival time in HCC with PVTT treated by radiotherapy ranges from 8.6 to 44.7 months. [29][30][31][32][33] Radiotherapy can be employed in unresectable locally advanced HCC patients with no extrahepatic metastasis, those of grade A/B in Child-Pugh Ratings, and those with the tumor volume being less than 2/3 of normal liver volume.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of three‐dimensional conformal radiotherapy and hepatic resection in hepatocellular carcinoma with portal vein tumor thrombus

Chen

Liang

et al. 2018

Cancer Medicine

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ObjectiveThis study aimed to evaluate the safety and efficacy of three‐dimensional conformal radiotherapy (3D‐CRT) and hepatic resection for patients with hepatocellular carcinoma (HCC) involving portal vein tumor thrombus (PVTT).MethodsWe retrospectively analyzed 323 HCC patients involving PVTT. Among them, 134 patients underwent 3D‐CRT, while 189 controls treated with hepatic resection (HR). Survival rate and prognostic analysis were performed using Kaplan‐Meier method and Cox regression analyses.ResultsThe 1‐, 2‐, and 3‐year overall survival (OS) of RT group and HR group was 54% vs 62%, 33% vs 47%, and 18% vs 43%, respectively (P = 0.003). In the subgroup of PVTT type analysis, the 1‐, 2‐, and 3‐year OS in RT group was 65%, 39%, and 19%, respectively, while that in HR group was 83%, 53%, and 42%, respectively, in type I PVTT (P < 0.001). The 1‐, 2‐, and 3‐year OS in RT group was 52%, 35%, and 11%, while that in HR group was 55%, 42%, and 25%, respectively, in type II PVTT (P = 0.612). In type III PVTT, the 1‐, 2‐, and 3‐year OS in RT group was 16%, 3%, and 0%, respectively, while that in HR group was 11%, 0%, and 0%, respectively (P = 0.041). Multivariate analysis revealed that tumor size ≥10 cm, Child‐Pugh class B, and type III PVTT are independent predictors of poor prognosis in HCC with PVTT.Conclusion3D‐CRT appears to be an effective treatment for patients with HCC involving type II/III PVTT.

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“…With the introduction of image guidance and conformal radiotherapy techniques, the treatment of both primary and secondary liver tumours has experienced significant improvement over the past few years, leading to increased local control rates and decreased normal tissue toxicity [14][15][16][17][18][19].…”

Section: Indications For Radiotherapymentioning

confidence: 99%

Radiomics for liver tumours

et al. 2020

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Current research, especially in oncology, increasingly focuses on the integration of quantitative, multiparametric and functional imaging data. In this fast-growing field of research, radiomics may allow for a more sophisticated analysis of imaging data, far beyond the qualitative evaluation of visible tissue changes. Through use of quantitative imaging data, more tailored and tumour-specific diagnostic work-up and individualized treatment concepts may be applied for oncologic patients in the future. This is of special importance in cross-sectional disciplines such as radiology and radiation oncology, with already high and still further increasing use of imaging data in daily clinical practice. Liver targets are generally treated with stereotactic body radiotherapy (SBRT), allowing for local dose escalation while preserving surrounding normal tissue. With the introduction of online target surveillance with implanted markers, 3D-ultrasound on conventional linacs and hybrid magnetic resonance imaging (MRI)-linear accelerators, individualized adaptive radiotherapy is heading towards realization. The use of big data such as radiomics and the integration of artificial intelligence techniques have the potential to further improve image-based treatment planning and structured follow-up, with outcome/toxicity prediction and immediate detection of (oligo)progression. The scope of current research in this innovative field is to identify and critically discuss possible application forms of radiomics, which is why this review tries to summarize current knowledge about interdisciplinary integration of radiomics in oncologic patients, with a focus on investigations of radiotherapy in patients with liver cancer or oligometastases including multiparametric, quantitative data into (radio)-oncologic workflow from disease diagnosis, treatment planning, delivery and patient follow-up.

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Safety and Efficacy of Accelerated Hypofractionation and Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma Patients With Varying Degrees of Hepatic Impairment

Cited by 36 publications

References 21 publications

Ultra-High Dose Rate (FLASH) Radiotherapy: Silver Bullet or Fool's Gold?

Ultra-High Dose Rate (FLASH) Radiotherapy: Silver Bullet or Fool's Gold?

Comparison of three‐dimensional conformal radiotherapy and hepatic resection in hepatocellular carcinoma with portal vein tumor thrombus

Radiomics for liver tumours

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