Stereotactic body radiation therapy in patients with hepatocellular carcinoma: A mini-review

Gerum, S.; Jensen, Alexandra D; Roeder, Falk

doi:10.4251/wjgo.v11.i5.367

Cited by 27 publications

(31 citation statements)

References 48 publications

(70 reference statements)

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“…Although RFA is more widely accepted as definitive or salvage therapy, external beam radiotherapy (including SBRT) is an emerging modality for the management of these patients. SBRT appears to result in similar local control rates and overall survival outcomes 22 with a potential advantage for Downloaded From: https://jamanetwork.com/ on 11/24/2020 treating larger tumors with improved local control of larger HCC lesions compared with RFA. 23 In this study, the benefit of ablative therapy was shown to be consistent for both smaller and larger HCC lesions.…”

Section: Discussionmentioning

confidence: 94%

Association of Addition of Ablative Therapy Following Transarterial Chemoembolization With Survival Rates in Patients With Hepatocellular Carcinoma

et al. 2020

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IMPORTANCE Hepatocellular carcinoma (HCC) is a heterogeneous disease with many available treatment modalities. Transarterial chemoembolization (TACE) is a valuable treatment modality for HCC lesions. This article seeks to evaluate the utility of additional ablative therapy in the management of patients with HCC who received an initial TACE procedure. OBJECTIVE To compare the overall survival (OS) and freedom from local progression (FFLP) outcomes after TACE alone with TACE that is followed by an ablative treatment regimen using stereotactic body radiation therapy, radiofrequency ablation, or microwave ablation for patients with HCC. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 289 adults at a single urban medical center examined survival outcomes for patients with nonmetastatic, unresectable HCC who received ablative therapies following TACE or TACE alone from January 2010 through December 2018. The Lee, Wei, Amato common baseline hazard model was applied for within-patient correlation with robust variance and Cox regression analysis was used to assess the association between treatment group (TACE vs TACE and ablative therapy) and failure time events (FFLP per individual lesion and OS per patient), respectively. In both analyses, the treatment indication was modeled as a time-varying covariate. Landmark analysis was used as a further sensitivity test for bias by treatment indication. EXPOSURES TACE alone vs TACE followed by ablative therapy. MAIN OUTCOMES AND MEASURES Freedom from local progression and overall survival. Hypotheses were generated before data collection. RESULTS Of the 289 patients identified, 176 (60.9%) received TACE only and 113 (39.1%) received TACE plus ablative therapy. Ablative therapy included 45 patients receiving stereotactic body radiation therapy, 39 receiving microwave ablation, 20 receiving radiofrequency ablation, and 9 receiving a combination of these following TACE. With a median (interquartile range) follow-up of 17.4 (9.5-29.5) months, 242 of 512 (47.3%) lesions progressed, 211 in the group with TACE alone and 31 in the group with TACE plus ablative therapy (P < .001). Over 3 years, FFLP was 28.1% for TACE alone vs 67.4% for TACE with ablative therapy (P < .001). The 1-year and 3-year OS was 87.5% and 47.1% for patients with lesions treated with TACE alone vs 98.7% and 85.3% for patients where any lesion received TACE plus ablative therapy, respectively (P = .01), and this benefit remained robust on landmark analyses at 6 and 12 months. The addition of ablative therapy was independently associated with OS on multivariable analysis for all patients (hazard ratio, 0.26; 95% CI, 0.13-0.49; (continued) Key Points Question Is the addition of ablative treatment using stereotactic body radiation therapy, radiofrequency ablation, or microwave ablation to transarterial chemoembolization associated with improved treatment outcomes and survival for patients with hepatocellular carcinoma (HCC)? Findings In this cohort study of 289 patients with HCC, the addition of ablative therapy...

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Section: Discussionmentioning

confidence: 94%

Association of Addition of Ablative Therapy Following Transarterial Chemoembolization With Survival Rates in Patients With Hepatocellular Carcinoma

et al. 2020

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“…Previous studies have demonstrated that the significant risk factors for recurrence mainly include the size of HCC lesions (especially sizes >3 cm), etiology, serum albumin levels and serum alpha-fetoprotein, while factors affecting survival include the patient's age and Child-Pugh stage [12][13][14][15]. Patient age is also considered to be related to post-treatment complications and disease morbidity [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…A previous study showed significant improved local recurrence in patients treated with SBRT for larger lesions than possible with RFA [8]. Current practice, using SBRT as a sole treatment or in combination with other local therapies (transcatheter arterial chemoembolization, resection), irrespective of small retrospective cohorts or larger series and well-designed phase II trials, has consistently confirmed the value of SBRT in the treatment of HCCs by encouraging local control (1 year, 65-100%), OS rates (1 year, 32-94%) and low toxicity [14]. In line with the previous study, our novel therapy of administering short-term RFA and SBRT exhibited an acceptable PFS rate in one year (66.7%) and a stable and high OS rate in continuing follow-up years (the 1, 3 and 5 year OS rates in case groups were 95.2%, 87.3% and 74.8%).…”

Section: Groupsmentioning

confidence: 93%

Safety and efficacy study: Short-term application of radiofrequency ablation and stereotactic body radiotherapy for Barcelona Clinical Liver Cancer stage 0–B1 hepatocellular carcinoma

et al. 2021

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Aim To evaluate the safety and efficacy of the administration of radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) in the short term to the same patients in Barcelona Clinical Liver Cancer (BCLC) stages 0–B1. Methods From April 2014 to June 2019, we retrospectively reviewed BCLC stage 0–B1 patients with fresh hepatocellular carcinoma (HCC) lesions that were repeatedly treated by RFA (control group, n = 72), and by RFA and subsequent SBRT (case group, n = 26). Propensity score matching (PSM) was performed to reduce the selection bias between two groups. Recurrence, survival, Child–Pugh scores and short-term side effects (fever, bleeding, skin change, abdominal pain and fatigue) were recorded and analyzed. Results After PSM, 21 patients remained in each group. Seventeen and 20 patients in the case and control groups experienced recurrence. For these patients, the median times to progression and follow-up were 10.7 and 35.8 months, respectively. After PSM, the 1-year progression-free survival rate in case and control groups were 66.7% and 52.4%, respectively (P = 0.313). The inter-group overall survival (OS) was comparable (3 and 5-year OS rates in case groups were 87.3% and 74.8%, while rates in control groups were 73.7% and 46.3%, respectively; P = 0.090). The short-term side effects were mild, and the incidence showed no inter-group difference. The 1-year rates of the Child–Pugh score deterioration of ≥2 in case and control groups were 23.8% and 33.3% (P > 0.05), respectively. Conclusion The short-term administration of RFA and SBRT to the same BCLC stage 0–B1 patients may be feasible and effective because of their good prognosis and safety.

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“…Loco-regional treatments in HCC are used in patients with early-stage (0-A BSCL staging) who are not eligible for surgical treatment or transplant, or in patients with advanced-stage (B-C BSCL) not amenable to kinase-inhibitor drugs (Sorafenib or Regorafenib). The most used local procedures are transarterial chemoembolization (TACE) ( 54 – 59 ), radiofrequency ablation (RFA) ( 60 ), stereotactic body radiotherapy (SBRT) ( 61 , 62 ), transarterial radioembolization, and embolization via microspheres loaded with yttrium-90 (Y-90) ( 63 – 65 ).…”

Section: Immune Checkpoint Inhibitors In Localized Hccmentioning

confidence: 99%

Immune Checkpoint Inhibitors in the Treatment of HCC

et al. 2021

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Hepatocellular carcinoma (HCC) is the typical inflammation-induced neoplasia. It often prospers where a chronic liver disease persists, thus leading a strong rationale for immune therapy. Several immune-based treatments, including immune checkpoint inhibitors (ICI), cytokines, adoptive cell transfer, and vaccines, have been tested in the treatment of HCC. In this review, we summarize the role of the ICI in HCC patients in various sets of treatment. As for advanced HCC, the anti-Programmed cell Death protein 1 (PD1) antibodies and the anti-Cytotoxic T-Lymphocyte Antigen 4 (CTLA-4) antibodies have been examined in patients with enthusiastic results in phase I-II-III studies. Overall, this led the Food and Drug Administration (FDA) to approve pembrolizumab, nivolumab, and nivolumab + ipilimumab in the second-line setting. The anti- Programmed Death-Ligand 1 (PDL-1) antibodies have also been evaluated. Thanks to the results obtained from phase III IMbrave study, atezolizumab + bevacizumab is now the standard of care in the first-line advanced setting of HCC. As for localized HCC, the putative immunological effect of locoregional therapies led to evaluate the combination strategy with ICI. This way, chemoembolization, ablation with radiofrequency, and radioembolization combined with ICI are currently under study. Likewise, the study of adjuvant immunotherapy following surgical resection is underway. In addition, the different ICI has been studied in combination with other ICI as well as with multikinase inhibitors and anti-angiogenesis monoclonal antibody. The evidence available suggests that combining systemic therapies and locoregional treatments with ICI may represent an effective strategy in this context.

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Stereotactic body radiation therapy in patients with hepatocellular carcinoma: A mini-review

Cited by 27 publications

References 48 publications

Association of Addition of Ablative Therapy Following Transarterial Chemoembolization With Survival Rates in Patients With Hepatocellular Carcinoma

Association of Addition of Ablative Therapy Following Transarterial Chemoembolization With Survival Rates in Patients With Hepatocellular Carcinoma

Safety and efficacy study: Short-term application of radiofrequency ablation and stereotactic body radiotherapy for Barcelona Clinical Liver Cancer stage 0–B1 hepatocellular carcinoma

Immune Checkpoint Inhibitors in the Treatment of HCC

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