Systematic review of patient reported quality of life following stereotactic ablative radiotherapy for primary and metastatic liver cancer

Mutsaers, Adam; Greenspoon, Jeffrey; Walker-Dilks, Cindy; Swaminath, Anand

doi:10.1186/s13014-017-0818-8

Cited by 24 publications

(13 citation statements)

References 34 publications

(23 reference statements)

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“…Another much less explored, but important, outcome is the quality of life of these patients who may struggle from symptoms of their HCC, underlying liver disease and/or treatment side effects, over a long time. 64 …”

Section: Future Directionsmentioning

confidence: 99%

Current Understanding of Ablative Radiation Therapy in Hepatocellular Carcinoma

Mathew¹,

Dawson²

2021

JHC

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The role of ablative stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma (HCC) has been evolving over the last few decades. SBRT has mostly been used in early stages of HCC, including few (≤ 3 in number) tumors, small tumours (< 3 cm in size), as well as larger tumours which are ineligible for other ablative modalities, mostly without vascular invasion. In early stage HCC, SBRT is used as a definitive treatment with curative intent or with intent to bridge to liver transplant. Retrospective and prospective institutional series document a high rate of local control (68–95% at 3 years) following SBRT. This coupled with a low risk of toxicity makes this non-invasive ablative treatment an attractive option for patients who are ineligible for other ablative treatments. Small randomized studies of ablative radiation have also shown non-inferiority of radiation as compared to radiofrequency ablation (RFA). Currently, SBRT is widely available as a safe and effective liver directed therapy, although there is a need for more studies providing higher level evidence. This review gives a brief overview of SBRT and the evidence for its use in HCC patients with ablative intent.

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Section: Future Directionsmentioning

confidence: 99%

Current Understanding of Ablative Radiation Therapy in Hepatocellular Carcinoma

Mathew¹,

Dawson²

2021

JHC

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“…Therefore SBRT treatment should be used with caution or restricted in dose in patients with already restricted pretreatment liver function (Child Pugh B) while SBRT seems to be generally well tolerated in patients with Child Pugh A or in patients with MD. Moreover, a recent systematic review including 5 studies with 392 patients suffering from primary and secondary liver tumors treated with SBRT demonstrated well-preserved post-treatment quality-of-life at least comparable or even favorable compared to other surgical or non-surgical approaches [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Primary and metastatic liver tumors are among the most common malignancies and tumour-related causes of death worldwide [ 1 , 2 ]. Treatment paradigms have changed dramatically in the last decades in favor of local treatments in primary liver cancers and oligometastatic (especially liver-confined) disease because of the evolving evidence for possible cure or at least long-term survival [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiation therapy (SBRT) in patients with hepatocellular carcinoma and oligometastatic liver disease

et al. 2018

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BackgroundTo report our experience with SBRT in primary and secondary liver tumors.MethodsWe retrospectively analysed 55 patients (70 lesions) with a median follow-up of 10 months (range 1–57) treated from 2011 to 2016. All patients had not been eligible for other local treatment options. Median age was 64 years and 64% were male. 27 patients (36 lesions) suffered from hepatocellular carcinoma (HCC, Child A:78%, Child B:18%, Child C:4%), 28 patients (34 lesions) had oligometastatic liver disease (MD). Treatment planning was based on 4D-CT usually after placement of fiducials. Dose and fractionation varied depending on localization and size, most commonly 3 × 12.5 Gy (prescribed to the surrounding 65%-isodose) in 56% and 5x8Gy (80% isodose) in 20% of the treated lesions.ResultsLocal recurrence was observed in 7 patients (13%) and 8 lesions (11%), resulting in estimated 1- and 2-year local control rates (LC) of 91 and 74%. Estimated 1- and 2-year rates of Freedom from hepatic failure (FFHF) were 42 and 28%. Number of lesions was predictive for LC and FFHF in the entire cohort. Estimated 1- and 2-year overall survival (OS) was 76 and 57%. OS was significantly affected by number of treated lesions and performance status. In the HCC subgroup, pretreatment liver function and gender were also predictive for OS. Maximum acute non-hepatic toxicity was grade 1 in 16% and grade 2 in 10% of the patients. Three HCC patients (11%) developed marked deterioration of liver function (grade 3/4).ConclusionsSBRT resulted in high local control and acceptable survival rates in patients with HCC or MD not amendable to other locally-ablative treatment options with limited toxicity. Care should be taken in HCC patients with Child B cirrhosis.

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“…The QOL endpoint was chosen because previous studies indicated that pretreatment QOL 99 and post-treatment QOL 100 are associated with OS in various cancers, and HCC-specific analysis indicates that QOL is a clinically important target. 101,102 A single-institution phase 2 trial from Michigan also compares HIGRT versus MWA for either nonsurgical candidates or as a bridge to transplantation. 103 One hundred patients are planned to be randomized, and the primary endpoint is freedom from local progression.…”

Section: Future Directionsmentioning

confidence: 99%

The role of external beam radiotherapy in the treatment of hepatocellular cancer

Chino

Stephens

Marin

et al. 2018

Cancer

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Hepatocellular carcinoma (HCC) is increasing in incidence and mortality. Although the prognosis remains poor, long-term survival has improved from 3% in 1970 to an 18% 5-year survival rate today. This is likely because of the introduction of well tolerated, oral antiviral therapies for hepatitis C. Curative options for patients with HCC are often limited by underlying liver dysfunction/cirrhosis and medical comorbidities. Less than one-third of patients are candidates for surgery, which is the current gold standard for cure. Nonsurgical treatments include embolotherapies, percutaneous ablation, and ablative radiation. Technological advances in radiation delivery in the past several decades now allow for safe and effective ablative doses to the liver. Conformal techniques allow for both dose escalation to target volumes and normal tissue sparing. Multiple retrospective and prospective studies have demonstrated that hypofractionated image-guided radiation therapy, used as monotherapy or in combination with other liver-directed therapies, can provide excellent local control that is cost effective. Therefore, as the HCC treatment paradigm continues to evolve, ablative radiation treatment has moved from a palliative treatment to both a "bridge to transplant" and a definitive treatment.

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Systematic review of patient reported quality of life following stereotactic ablative radiotherapy for primary and metastatic liver cancer

Cited by 24 publications

References 34 publications

Current Understanding of Ablative Radiation Therapy in Hepatocellular Carcinoma

Current Understanding of Ablative Radiation Therapy in Hepatocellular Carcinoma

Stereotactic body radiation therapy (SBRT) in patients with hepatocellular carcinoma and oligometastatic liver disease

The role of external beam radiotherapy in the treatment of hepatocellular cancer

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