Three-dimensional Conformal Radiation Therapy for Unresectable Hepatocellular Carcinoma Patients who had Failed with or were Unsuited for Transcatheter Arterial Chemoembolization

Liu, Mu-Tai; Li, Shih-Hai; Chu, T. L.; Hsieh, Chang‐Yao; Wang, Ai-Yih; Chang, Tse Wen; Pi, Chu-Ping; Huang, Chia‐Wei; Lin, Jao-Perng

doi:10.1093/jjco/hyh089

Cited by 95 publications

(49 citation statements)

References 31 publications

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“…The most common approaches include the use of 1 TACE procedure followed by RT, RT sandwiched between TACE procedures, 6 or repetitive TACE until optimal response or Ͼ 50% of normal liver is replaced by HCC followed by RT. 71 The interval between TACE and RT varies from 7 to 14 days, 10,62 3 to 4 weeks, 63,75 4 to 8 weeks, 39,61 and longer if RT is used as salvage therapy for tumor progression after TACE 10,70 (Table 4). A planned combined approach has some advantages over reserving RT as salvage therapy.…”

Section: Radiation and Tacementioning

confidence: 99%

“…The partial response rates range from 25% 71 to 78% 63 at 1 month after RT, with complete response rates as high as 13%. 6,39,63 The 2-year and 5-year survival rates range from 10.2% to 53.8% and from 9% to 19%, respectively. [61][62][63]66 The heterogeneity of disease, patients, and treatment make comparisons of reported series limited.…”

Section: Radiation and Tacementioning

confidence: 99%

“…With such advances, 10,[37][38][39][40][41][42] it has been possible to deliver far higher doses to unresectable HCC than was previously possible with a low risk of complications. An example of a typical conformal radiation plan for a patient with HCC is displayed in Figure 1.…”

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confidence: 99%

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Radiation therapy for hepatocellular carcinoma

Hawkins

Dawson

2006

Cancer

221

171

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Technologic advances have provided the means to deliver tumoricidal doses of radiation therapy (RT) to patients with unresectable hepatocellular carcinoma (HCC) while avoiding critical normal tissues, providing the opportunity to use RT for curative intent treatment of HCC. For the current report, the expanded role of external beam RT in the setting of HCC from palliation to cure was reviewed. A systematic literature search was undertaken using the MEDLINE data base and secondary references to identify peer-reviewed, English-language articles that re- control response rates ranged from 40% to 90%, and the median survival ranges from 10 months to 25 months. For patients with HCC who had portal vein thrombus, the median survival after RT to treat the thrombus and/or the hepatic tumor with or without TACE ranged from 5.3 months to 9.7 months. Although outcomes after high-dose conformal RT for liver-confined HCC were excellent, the potential survival benefit of RT should be tested in randomized controlled trials that require international collaboration.

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Section: Radiation and Tacementioning

confidence: 99%

Section: Radiation and Tacementioning

confidence: 99%

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Radiation therapy for hepatocellular carcinoma

Hawkins

Dawson

2006

Cancer

221

171

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“…When using X-ray or gamma-rays in SBRT, it may be referred to as X-knife or gamma-knife. The application of SBRT technology in the treatment of liver cancer has gradually been proven to be a safe and effective option (12)(13)(14)(15)(16) (18) reported a curative effect with the 'gamma-knife' in 56 patients with primary liver cancer, with an effective rate of 71.5% and a median survival time of 10.6 months; of note, the effective rate for tumor diameter <5 cm was 90%. SBRT for liver metastases over the last few years has exhibited satisfactory curative effects (19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

Curative effect of stereotactic body radiotherapy on hepatic hilar carcinoma

Dang

Huang

et al. 2014

Molecular and Clinical Oncology

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Abstract. This study was conducted to investigate the effect of stereotactic body radiotherapy (SBRT) on hepatic hilar tumors. Between October, 2006 and October, 2012, we analyzed 63 unresectable hepatic hilar tumors that were treated by SBRT at the Department of Radiation Oncology, 323 Hospital of the People's Liberation Army, Xi'an, China. The patients received a total radiation dose of 45 Gy (range, 44-48 Gy) with a dose fractionation of 3-6 Gy/fx, administered for a total of 9-12 times, 2-5 times/week. At 1 and 3 months we evaluated therapeutic efficacy and 1-and 2-year survival rate. At 1 month, the patients exhibiting complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) were 15 (23.8%), 34 (54.0%), 11 (17.5%) and 3 (4.7%), respectively. At 3 months, the number of cases with CR, PR, SD and PD was 22 (34.9%), 32 (50.8%), 3 (4.8%) and 6 (9.5%), respectively. The total effective rate, defined as CR + PR, was 85.7% (54/63). The number of patients with a tumor diameter of ≤5 cm in the CR, PR, SD and PD groups was 13 (72.2%), 4 (22.2%), 1 (5.6%) and 0 (0.0%), respectively. The number of patients with a tumor diameter of >5 cm in the CR, PR, SD and PD groups was 9 (20.0%), 28 (62.2%), 6 (13.3%) and 2 (4.5%), respectively. The 1-year survival rate of patients with a tumor diameter >5 cm was 71.4% (45/63) and the 2-year survival rate was 42.9% (27/63). In conclusion, SBRT appears to be a safe and effective treatment for hepatic hilar tumors.

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“…20 Other studies have reported 2 year survival of 10% to 55% with combination of TACE and radiation. [21][22][23][24] A metananlyses from China, that included 5 randomized trials (in Chinese language) and 12 prospective studies included 1476 patients concluded that addition of RT to TACE can lead to 10-35% improvement in overall survival and higher odds of survival at 3 and 5 years. 25 Though the metanalyses included 5 randomized trials the methodological quality of trials was considered suboptimal and authors recommended the need for well conducted randomized studies investigating the role of additional RT.…”

Section: Introductionmentioning

confidence: 99%

Protocol for an integrated phase II/III randomised controlled trial of transarterial chemotherapy and sorafenib with or without stereotactic body radiation therapy in patients with nonmetastatic unresectable hepatocellular carcinoma

et al. 2017

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Background: Vast majority of patients with hepatocellular carcinoma (HCC) present with unresectable disease. In the last decade results of randomized trials and subsequent meta-analyses established trans-arterial chemoembolization (TACE) as standard of care in patients with Barcelona clinic liver cancer (BCLC) stage B. However, there is clearly a need to investigate additional therapeutic options that would consolidate the initial response to TACE. A recent meta-analyses concluded that addition of radiation to TACE had 10-35% improvement in two-year overall survival, however as results of meta-analyses were based on small studies, the need for conducting a high quality randomized study was highlighted. The present study is designed to investigate the role of high dose stereotactic radiation as consolidation therapy after TACE in patients with non-metastatic unresectable HCC. Methods: Patients diagnosed with non-metastatic unresectable HCC with BCLC stage B/A (medically inoperable) and Child-Pugh's score A-B7 will be eligible. The trial will randomize patients into TACE alone arm or TACE followed by stereotactic body radiation therapy (SBRT). The primary aim is to compare in-field progression free survival (PFS) in phase II and overall survival in phase III between the control (TACE) and intervention arm (TACE+SBRT). The secondary aim is to compare cause specific survival, imaging response and quality of life in control and intervention arms. Results: First analysis of the study has been planned when patient accrued under phase II study have completed 1 year follow up.

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Three-dimensional Conformal Radiation Therapy for Unresectable Hepatocellular Carcinoma Patients who had Failed with or were Unsuited for Transcatheter Arterial Chemoembolization

Cited by 95 publications

References 31 publications

Radiation therapy for hepatocellular carcinoma

Radiation therapy for hepatocellular carcinoma

Curative effect of stereotactic body radiotherapy on hepatic hilar carcinoma

Protocol for an integrated phase II/III randomised controlled trial of transarterial chemotherapy and sorafenib with or without stereotactic body radiation therapy in patients with nonmetastatic unresectable hepatocellular carcinoma

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