Stereotactic body radiotherapy versus intensity-modulated radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis

Li, Liqing; Zhou, Ying; Huang, Yong; Liang, Ping; Liang, Shi-Xiong; Su, Ting-Shi

doi:10.1007/s12072-021-10173-y

Cited by 21 publications

(25 citation statements)

References 30 publications

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“…Compared with 3D-CRT, IMRT provides a survival benefit in HCC with MVI (29). Meanwhile, a study showed median OS and LCR in the IMRT group were similar to those of the SBRT group for HCC with MVI (47). However, study about IMRT for HCC with MVI is scarce, and the clinical efficacy requires more clinical data to support.…”

Section: Discussionmentioning

confidence: 99%

Comparison of External Beam Radiation Therapy Modalities for Hepatocellular Carcinoma With Macrovascular Invasion: A Meta-Analysis and Systematic Review

Huang

et al. 2022

Front. Oncol.

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PurposeWe performed a systematic review and meta-analysis to compare external beam radiation therapy modalities for hepatocellular carcinoma (HCC) with macrovascular invasion (MVI).MethodsStudies were selected from online databases from the date of inception to November 2021. The outcomes of interest were overall survival (OS), objective response rate (ORR), and local control rate (LCR).ResultsForty-four studies (n = 3730) were selected from 1050 articles. The pooled 1-year OS were 60.9%, 45.3%, and 44.9 for particle radiotherapy (PRT) group, conventional radiotherapy (CRT), and stereotactic body radiotherapy (SBRT) group, respectively; p = 0.005 and 0.002 for PRT vs. CRT and SBRT, respectively. Both the PRT group and the SBRT group have the advantage over the CRT group in the pooled ORR. The PRT group showed significantly higher than the CRT group (p = 0.007) in LCR. For combination therapy, CRT plus transarterial chemoembolization can prolong survival than CRT alone (p = 0.006 for 1-year OS; p = 0.014 for 2-year OS). Among grade ≥ 3 complications, the most frequent type of toxicity in CRT, SBRT, PRT group was hematological toxicity, hepatotoxicity, dermatological toxicity, respectively.ConclusionsAmong patients with HCC with MVI, the 1-year OS and the 2-year OS were both higher in the PRT group than in the CRT, SBRT groups. The ORR was similar between the PRT and SBRT groups. The combination therapy based on radiotherapy is expectable. PRT is associated with less complications than photon radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Comparison of External Beam Radiation Therapy Modalities for Hepatocellular Carcinoma With Macrovascular Invasion: A Meta-Analysis and Systematic Review

Huang

et al. 2022

Front. Oncol.

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“…Similarly, a retrospective analysis of 19 HCC patients with IVC thrombus treated with conventional RT or SBRT showed evidence that RT is feasible and safe with acceptable toxicity in this patient group [ 22 ]. SBRT was found to be non-inferior to IMRT regarding overall survival, progression-free survival, and local control with the additional advantage of decreased overall treatment duration [ 23 ]. Xi et al retrospectively evaluated 41 HCC patients with TT in either the portal vein or IVC treated with SBRT.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Image-Guided Hypofractionated Ablative Radiation Therapy for Hepatocellular Carcinoma With Tumor Thrombus Extending to the Right Atrium

Dinçer¹,

Uğurluer²,

Mustafayev³

et al. 2022

Cureus

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Hepatocellular carcinoma (HCC) presenting with tumor thrombus (TT) and inferior vena cava (IVC)/right atrium (RA) infringement point to an advanced-stage disease that is deemed inoperable. Stereotactic body radiotherapy is an emerging treatment option for this group of patients with promising outcomes in recent studies that are comparable to conventional treatment methods, namely, transarterial chemoembolization and transarterial radioembolization. Here, we report a case of HCC with RA extension through the IVC. The patient was referred to our clinic for treatment options, and he was found suitable for magnetic resonance imaging-guided radiotherapy (MRgRT). We treated the patient with MRgRT in five fractions to a total dose of 40 Gray. The tumor was tracked during the treatment sessions, and adaptive treatment planning was performed before each fraction. The patient tolerated the treatment well with no acute grade 3-4 toxicities. The last follow-up showed that the patient had a complete biochemical response and is now a candidate for an orthotopic liver transplant. To our knowledge, this report is the first to document the MRgRT treatment of an HCC with TT and RA extension. MRgRT is safe and feasible for this patient group and can be an effective bridging therapy for liver transplants.

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“…Kim et al reported that RT with a BED of 58 Gy 10 or higher improved tumor response and overall survival (OS) in HCC patients with PVTT. Li et al compared the treatment effect between IMRT and SBRT technique in HCC patients with PVTT; OS and progression-free survival were better when BED 100 Gy 10 or higher was prescribed, regardless of the technique (Li et al 2021). High BED RT could be considered as one of the treatment options that may improve tumor response and survival in HCC patients with PVTT.…”

Section: Discussionmentioning

confidence: 99%

MRI-guided Radiotherapy for PVTT in HCC Patients: Evaluation of the Efficacy and Safety

Lee

Kim

Kwak

et al. 2021

Preprint

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PurposeThis study aims to evaluate to efficacy, feasibility, and safety of the tumor tracking magnetic resonance imaging (MRI)-guided hypofractionated radiotherapy (HFRT) and stereotactic body radiation therapy (SBRT) for portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) patients.MethodsWe retrospectively reviewed the twelve cases of unresectable HCC with tumor thrombus in the main trunk or first branch of the portal vein that were treated with tumor tracking MRI-guided HFRT or SBRT using the ViewRay Linac MRIdian system between June 2019 and January 2021. The HFRT was performed with a total of 50 Gy in 10 fractions, and SBRT performed in a range of 36-50 Gy with 4-5 fractions. The median biologic effective dose (BED) with an a/b ratio of 10 was 75 Gy10 (range, 68.4–100 Gy10). ResultsThe median follow-up duration was 5.0 months (range, 1.7–12.8 months). Ten patients (83.3%) showed an objective response of PVTT. At the time of analysis, 10 patients (83.3%) showed local control. The median survival of these patients was 11.6 months (range, 1.9–12.8 months). Three patients (25%) showed mild gastrointestinal symptoms, and there were no cases of grade 3 or higher toxicity. For hepatic toxicity, there were no cases of Child-Puch score increased by more than 2 points after RT without disease progression. ConclusionTumor tracking MRI-guided HFRT and SBRT was a feasible, effective, and safe treatment option in HCC patients with tumor thrombi in the main trunk or first branch of the portal vein.

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Stereotactic body radiotherapy versus intensity-modulated radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis

Cited by 21 publications

References 30 publications

Comparison of External Beam Radiation Therapy Modalities for Hepatocellular Carcinoma With Macrovascular Invasion: A Meta-Analysis and Systematic Review

Comparison of External Beam Radiation Therapy Modalities for Hepatocellular Carcinoma With Macrovascular Invasion: A Meta-Analysis and Systematic Review

Magnetic Resonance Image-Guided Hypofractionated Ablative Radiation Therapy for Hepatocellular Carcinoma With Tumor Thrombus Extending to the Right Atrium

MRI-guided Radiotherapy for PVTT in HCC Patients: Evaluation of the Efficacy and Safety

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