Stereotactic Body Radiotherapy for Patients With Unresectable Primary Hepatocellular Carcinoma: Dose-Volumetric Parameters Predicting the Hepatic Complication

Son, Seung Hyun; Choi, Byung Ock; Ryu, Mi-Ryeong; Kang, Yun Ju; Jang, Ju-Seog; Bae, Si Hyun; Yoon, Seung Kew; Choi, Inyoung; Kang, Ki Mun; Jang, Hong Seok

doi:10.1016/j.ijrobp.2009.09.009

Cited by 129 publications

(98 citation statements)

References 27 publications

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“…Deaths from liver failure are reported in up to 13% (most often in CP B patients) and high-grade luminal toxicities occur in up to 11% of patients 13,14 . Normal liver doses and the severity of cirrhosis are important in predicting hepatic toxicity 15,16,[25][26][27] . Classic and non-classic radiation-induced liver disease (RILD) have been described 28 SBRT and TACE to TACE alone in tumours ≥3cm and ≤3cm respectively in retrospective series 32,33 .…”

Section: Clinical Evidence: Prospective Datamentioning

confidence: 99%

“…Breath hold techniques using Activated Breathing Control devices 15,25,29 have been used to reduce respiratory motion 51 . Abdominal compression with 4D-CT have also been used to reduce respiratory motion 19,21,50,52 as has respiratory gating 29,32,41 and intra-fraction tracking of peri-tumoral implanted fiducials 22,30,34,42,48 or external surface markers 20,22,30,43,48 (which requires daily imaging to ensure the adopted breathing model remains satisfactory).…”

Section: Respiratory Motion Managementmentioning

confidence: 99%

“…40Gy in 5 fractions), but for larger tumours, where doses must be limited because of normal liver tolerance, an individualised strategy, based on escalating dose based on liver constraints, is most appropriate. Varying approaches to dose selection have been adopted and include a biological individualised strategy based on the effective volume of irradiated liver and Lyman normal tissue complication probability (NTCP) estimation of classic RILD 15,53 , or a critical volume approach, which limits the dose received by a specified volume of normal liver 14,17,21,23,25 (often 700ml).…”

Section: Planningmentioning

confidence: 99%

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Advances in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Murray

Dawson

2017

Seminars in Radiation Oncology

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SBRT is an emerging effective treatment for hepatocellular carcinoma (HCC) associated with acceptable rates of toxicity in appropriately selected patients. Despite often being reserved for patients unsuitable for other local treatments, prospective and retrospective studies have demonstrated excellent long-term control. SBRT may be used as a stand-alone treatment, or as an adjunct to other HCC therapies. Based on available data, SBRT appears to complement existing local liver therapies.Randomised and non-randomized comparative studies are required to better determine the optimal role of SBRT in HCC treatment.

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Section: Clinical Evidence: Prospective Datamentioning

confidence: 99%

Section: Respiratory Motion Managementmentioning

confidence: 99%

Section: Planningmentioning

confidence: 99%

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Advances in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Murray

Dawson

2017

Seminars in Radiation Oncology

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“…Tumor volume significantly predicted progression-free survival rate at 1 year. Additional analysis from that institution [80] evaluated dosimetric predictors of hepatotoxicity and observed 33% incidence of grade II or higher toxicity, with an 11% probability of progression of CP class. The hepatic liver volume receiving ≤18 Gy emerged as the only significant predictor of progression of CP class using three-fraction SBRT, and the authors recommended a minimum 800 cc of liver should receive ≤18 Gy to prevent the risk of deterioration of hepatic function.…”

Section: Recent Experience With Sbrt For Plcmentioning

confidence: 99%

External radiation treatment of malignant liver disease: a critical review

et al. 2012

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Introduction Owing to the liver's integral role in biosynthesis and homeostasis, management of primary and secondary malignancies arising in this organ is of paramount oncologic significance. Over the past several decades, substantial progress has been achieved in the imaging and treatment of early and advanced hepatic malignancies. Radiation therapy (RT) has recently emerged as one of many local therapeutic options for both primary and metastatic liver cancer. Recent phase I and II studies describe promising efficacy and side effect profile; however, phase III studies are needed to establish RT among standard of care therapeutic modalities. Purpose In this review, we will describe (a) the scope, epidemiology, and standard treatment options for liver cancer; (b) relevant diagnostic imaging techniques; and (c) provide an in-depth review of RT treatment techniques, dose-volume limits of normal tissues, and results of both conventional and hypofractionated RT liver trials pertaining to primary and secondary liver cancers with emphasis on three-dimensional conformal radiation therapy (3DCRT) and stereotactic body radiotherapy (SBRT) studies.

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“…Despite the lack of randomized controlled trials, radiotherapy is becoming recognized as a potentially curative treatment option (13). Conformal radiotherapy (CRT) for HCC was reported to exert a significant effect (14)(15)(16), as was SBRT (17)(18)(19)(20). However, the number of studies on the application of CRT and SBRT for the treatment of huge HCCs is limited.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy combined with transarterial chemoembolization for huge (≥10 cm) hepatocellular carcinomas: A clinical study

Zhong

Chen

2014

Molecular and Clinical Oncology

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Abstract. This study was conducted to evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) combined with transarterial chemoembolization (TACE) for huge (≥10 cm) hepatocellular carcinomas (HCCs). Between May, 2006 and December, 2012, 72 patients with huge HCCs were treated by SBRT following incomplete TACE. The median total dose of 35.6 Gy was delivered over 12-14 days with a fractional dose of 2.6-3.0 Gy and 6 fractions per week. The patients were classified into those with tumor encapsulation (group A, n=33) and those without tumor encapsulation (group B, n=39). The clinical outcomes of tumor response, overall cumulative survival and toxicities/complications were retrospectively analyzed. Among the 72 patients, CR, PR, SD and PD were achieved in 6 (8.3%), 51 (70.8%), 9 (12.5%) and 6 patients (8.3%), respectively, within a median follow-up of 18 months. The objective response rate was 79.1%. The overall cumulative 1-, 3-and 5-year survival rates and the median survival time were 38, 12 and 3% and 12.2 months, respectively. In group A, the overall cumulative 1-, 3-and 5-year survival rates were 56, 21 and 6%, respectively, with a median survival of 19 months; in group B, the overall cumulative 1-, 3-and 5-year survival rates were 23, 4 and 0%, respectively, with a median survival of 10.8 months (P=0.023). The treatment was well tolerated, with no severe radiation-induced liver disease and no reported > grade 3 toxicity. Tumor encapsulation was found to be a significant prognostic factor for survival. In conclusion, the combination of SBRT and TACE was shown to be a safe and effective treatment option for patients with unresectable huge HCC.

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Stereotactic Body Radiotherapy for Patients With Unresectable Primary Hepatocellular Carcinoma: Dose-Volumetric Parameters Predicting the Hepatic Complication

Cited by 129 publications

References 27 publications

Advances in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Advances in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

External radiation treatment of malignant liver disease: a critical review

Stereotactic body radiotherapy combined with transarterial chemoembolization for huge (≥10 cm) hepatocellular carcinomas: A clinical study

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