Stereotactic Body Radiation Therapy in Recurrent Hepatocellular Carcinoma

Huang, Wen; Jen, Yee‐Min; Lee, Meei Shyuan; Chang, Lynn; Chen, Chang Ming; Ko, Kai Hsiung; Lin, Kuen‐Tze; Lin, Jerry W.; Chao, Hsing‐Lung; Lin, Chun–Shu; Su, Yu Fu; Fan, Chao; Chang, Yao-Wen

doi:10.1016/j.ijrobp.2011.11.058

Cited by 165 publications

(141 citation statements)

References 20 publications

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“…These 4 patients were Child‐Pugh class B with other active HCCs, although it was difficult to conclude whether the cause of death was radiation‐induced liver failure, tumor progression, side effects caused by other therapies, or the natural course of their liver disease. In fact, this study revealed that patients classified as Child‐Pugh class B had a significantly higher mortality rate than those classified as Child‐Pugh class A; this finding is similar to reports evaluating SBRT9, 30 and proton therapy 12, 31. This suggests that patients with poor liver function, such as those who have Child‐Pugh class B or worse disease, and especially those with other active HCCs should be treated with caution when they are undergoing radiotherapy, including CIRT.…”

Section: Discussionsupporting

confidence: 90%

Progressive hypofractionated carbon‐ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials

Kasuya

Kato²,

Yasuda

et al. 2017

Cancer

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BACKGROUNDThe objective of this study was to evaluate the safety and efficacy of carbon‐ion radiotherapy (CIRT) in patients with hepatocellular carcinoma (HCC) with stepwise dose escalation and hypofractionation in 2 combined prospective trials.METHODSSequential phase 1/2 (protocol 9603) and phase 2 (protocol 0004) trials were conducted for patients with histologically proven HCC. The phase 1 component of protocol 9603 was a dose‐escalation study; CIRT was delivered in 12, 8, or 4 fractions. After determination of the recommended dose, 2 phase 2 trials were performed in an expanded cohort, and the data were pooled to analyze toxicity, local control, and overall survival.RESULTSIn the phase 1 component of protocol 9603, 69.6, 58.0, and 52.8 Gy (relative biological effectiveness [RBE]) in 12, 8, and 4 fractions, respectively, constituted the maximum tolerated doses, and 52.8 Gy (RBE) in 4 fractions was established as the recommended dose regimen for the 2 phase 2 studies. In 124 patients with a total of 133 lesions, few severe adverse effects occurred, and local‐control and overall survival rates at 1, 3, and 5 years were 94.7% and 90.3%, 91.4% and 50.0%, and 90.0% and 25.0%, respectively; this included 1‐, 3‐, and 5‐year local‐control rates of 97.8%, 95.5%, and 91.6%, respectively, in the phase 2 study. In a multivariate analysis, Child‐Pugh class B and the presence of a tumor thrombus were significant factors for mortality.CONCLUSIONSThe safety and efficacy of CIRT in 12, 8, and 4 fractions were confirmed, with 52.8 Gy (RBE) in 4 fractions established as the recommended treatment course for eligible HCC patients. Cancer 2017;123:3955‐65. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

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Section: Discussionsupporting

confidence: 90%

Progressive hypofractionated carbon‐ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials

Kasuya

Kato²,

Yasuda

et al. 2017

Cancer

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“…Aggressive treatment with a multimodality approach was suggested for patients with intrahepatic recurrence following curative resection and the survival of patients who underwent additional therapy was significantly improved (14). A number of adjuvant therapeutic options are currently available, including repeat hepatectomy, liver transplantation, radiofrequency ablation, TACE, hepatic arterial radioembolization, or radiation (stereotactic body radiation therapy and proton therapy) (15)(16)(17)(18)(19). In addition, antiangiogenic therapy, particularly sorafenib, has become the standard of care for patients with advanced HCC (20).…”

Section: Discussionmentioning

confidence: 99%

Vascular invasion affects survival in early hepatocellular carcinoma

Hsieh

Wei

Yin

et al. 2014

Molecular and Clinical Oncology

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Abstract. Hepatocellular carcinoma (HCC) is an aggressive malignant tumor with a high mortality rate. The optimal therapeutic choice for early HCC is surgical resection. However, the rate of intrahepatic recurrence is high. The objective of this study was to evaluate the effect of various factors on the survival of patients with early HCC. Between January 1st, 2006 and December 31st, 2013, a total of 89 patients who underwent surgery for HCC were retrospectively enrolled. The analysis was conducted using the Student's t-test, Chi-square test, Kaplan-Meier method and Cox proportional hazard regression model to assess potential confounding and predictive variables. The 3-year overall survival (OS) rate was 71%. The 3-year OS rates in patients with and those without vascular invasion were 62.1 and 92.8%, respectively (P<0.003). Based on the multivariate analysis, postoperative pathological vascular invasion (hazard ratio = 4.96; 95% confidence interval: 1.55-15.9) remained an independent predictor of adverse long-term outcome. Furthermore, vascular invasion was significantly associated with intrahepatic metastasis. These data emphasize the need for effective adjuvant therapy in selected high-risk patients with early HCC. Further studies are required to determine the optimal approach to further improving the prognosis of early HCC.

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“…Certain works limit themselves to the RECIST criteria. [18][19][20][21][22] Other publications apply recommended EASL or mRECIST criteria. [23][24][25][26][27] A single article compared the RECIST and EASL criteria in this indication.…”

Section: Evaluation Of Response After Sbrt For Primary Hepatic Tumorsmentioning

confidence: 99%

Evaluation of response after SBRT for liver tumors

Tétreau

Llacer

Riou

et al. 2017

Reports of Practical Oncology & Radiotherapy

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Use of RECIST criteria is also inadequate in the evaluation of response after SBRT for hepatic metastases. Response of liver metastases to SBRT is better assessed with a combination of size and enhancement pattern. The occurrence of a lobulated enhancement during follow up is efficient to predict local progression in a specific, reproducible, and sensitive way. Patients with FDG-avid hepatic metastases are also better evaluated with PET-CT and functional criteria than routine imaging and metric evaluation alone.

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Stereotactic Body Radiation Therapy in Recurrent Hepatocellular Carcinoma

Cited by 165 publications

References 20 publications

Progressive hypofractionated carbon‐ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials

Progressive hypofractionated carbon‐ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials

Vascular invasion affects survival in early hepatocellular carcinoma

Evaluation of response after SBRT for liver tumors

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