Stereotactic ablative radiotherapy for unresectable hepatocellular carcinoma patients who failed or were unsuitable for transarterial chemoembolization

Lo, Cheng‐Hsiang; Huang, Wen‐Yen; Lee, Meei-Shyuan; Lin, Kun-Tze; Lin, Te-Pao; Chang, Ping‐Ying; Fan, Chao-Yueh; Jen, Yee‐Min

doi:10.1097/meg.0000000000000032

Cited by 23 publications

(29 citation statements)

References 8 publications

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“…A similar study by Lo et al of 53 patients with unresectable HCC and a median tumor size of 4.3 cm (1‐13 cm) underwent stereotactic body radiotherapy. The study demonstrated a median OS of 20 months . With the reported 14‐ and 20‐month OS, these studies exhibit similar survival rates to the current study of 14 months for 3‐5 cm HCC lesions.…”

Section: Discussionsupporting

confidence: 81%

“…Previously cited XRT studies have included up to 3 HCC lesions and patients with Barcelona Clinic Liver Cancer (BCLC) A‐C staging. Indeed, the 2014 Lo study was comprised of a majority (83%) of BCLC stage C patients . While the SEER set does not provide adequate data to determine disease‐related symptomatology as in the BCLC staging system, the current study examined single‐lesion disease only .…”

Section: Discussionmentioning

confidence: 99%

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External radiation or ablation for solitary hepatocellular carcinoma: A survival analysis of the SEER database

Berger

Tanious

Hammad

et al. 2017

Journal of Surgical Oncology

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

External radiation or ablation for solitary hepatocellular carcinoma: A survival analysis of the SEER database

Berger

Tanious

Hammad

et al. 2017

Journal of Surgical Oncology

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“…In keeping with previously published data [13, 17, 18], the local control rate in our study was very high, with only one infield progression. The outfield progression rate was 37%, which is somewhat lower than what was found in the study by Lo et al [19]. This high rate can be explained by the cirrhotic disease, which may favor intra-hepatic occurrence of new lesions; as well as the local nature of SBRT treatment, like RFA.…”

Section: Discussionmentioning

confidence: 55%

Tumor response assessment by MRI following stereotactic body radiation therapy for hepatocellular carcinoma

et al. 2017

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BackgroundTo evaluate the MRI features of a tumor response, local control, and predictive factors of local control after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC).MethodsThirty-five consecutive patients with 48 HCCs who were treated by SBRT were included in this retrospective study. All patients provided written informed consent to be treated by SBRT, and prior to inclusion they authorized use of the treatment data for further studies. The assessment was made using MRI, with determination of local and hepatic responses according to Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) criteria during a two-year follow-up.ResultsThe local response rate according to mRECIST was higher than with RECIST. A tumor diameter less than 20 mm at baseline was an independent predictive factor for RECIST and mRECIST responses, as was diffusion-weighted signal for RECIST. During follow-up, a tumor diameter of <20 mm (p = 0.034) and absence of a high intensity on T2-weighted (p = 0.006) and diffusion-weighted images (p = 0.039) were associated with a better response according to RECIST. Post-treatment changes include peritumoral ring-like enhanced changes with high intensity on T2-weighted images.ConclusionsSBRT is a promising technique for the treatment of inoperable HCC. Post-treatment changes on MRI images can resemble tumor progression and as such must be adequately distinguished. The regression of tumorous enhancement is variable over time, although diffusion-weighted and T2-weighted intensities are predictive factors for tumor RECIST responses on subsequent MRIs. They hence provide a way to reliably predict treatment responses.

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“…In all patients, SABR was performed using the CyberKnife ® image-guided radiosurgery system, and our previous reports have provided details regarding the preparation, CT simulation, dose volume constraints, and treatment [11, 14]. All patients were advised to undergo CT-guided implantation of 5–6 gold fiducials in or near the tumor; these acted as radiographic markers for the Synchrony respiratory motion-tracking system (Accuray Inc., Sunnyvale, CA, USA).…”

Section: Methodsmentioning

confidence: 99%

Survival and prognostic factors for patients with advanced hepatocellular carcinoma after stereotactic ablative radiotherapy

Yang

Liu

et al. 2017

PLoS ONE

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ObjectiveTo evaluate the survival outcomes and prognostic factors of patients with advanced hepatocellular carcinoma (HCC) who underwent stereotactic ablative radiotherapy (SABR).MethodsThis retrospective study evaluated patients with advanced HCC who underwent SABR between December 2007 and July 2015. All patients had Barcelona Clinic Liver Cancer stage C disease and Child–Turcotte–Pugh (CTP) class A–B function. In-field control (IFC), overall survival (OS), prognostic factors, and toxicity were evaluated.ResultsIn this study of 89 patients, the 3-year IFC rate was 78.1%, and the 1-year and 3-year OS rates were 45.9% and 24.3%, respectively. The multivariate analysis revealed that CTP class, the presence of main portal vein tumor thrombosis, and the presence of extrahepatic spread were independent predictors of OS. The expected median OS values among patients with ≥2, 1, and 0 predictors were 4.2, 8.6, and 26.4 months, respectively (p <0.001).ConclusionsSABR may be useful for patients with advanced HCC, and patient selection could be based on the CTP classification, main portal vein tumor thrombosis, and extrahepatic spread.

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Stereotactic ablative radiotherapy for unresectable hepatocellular carcinoma patients who failed or were unsuitable for transarterial chemoembolization

Abstract: Our findings supported the feasibility of SABR as a salvage treatment for HCC when transarterial chemoembolization was ineffective or technically unsuitable. Additional efforts to improve the response rate and reduce out-field recurrence are required.

Cited by 23 publications

References 8 publications

External radiation or ablation for solitary hepatocellular carcinoma: A survival analysis of the SEER database

External radiation or ablation for solitary hepatocellular carcinoma: A survival analysis of the SEER database

Tumor response assessment by MRI following stereotactic body radiation therapy for hepatocellular carcinoma

Survival and prognostic factors for patients with advanced hepatocellular carcinoma after stereotactic ablative radiotherapy

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