Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy

Lasley, Foster D.; Mannina, Edward M.; Johnson, Cynthia S.; Perkins, Susan M.; Althouse, Sandra K.; Maluccio, Mary A.; Kwo, Paul Y.; Cárdenes, Higinia R.

doi:10.1016/j.prro.2015.02.007

Cited by 165 publications

(124 citation statements)

References 11 publications

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“…The sparing of the normal liver and other surrounding structures from high doses while delivering significant dose to the tumor results in a safe and effective therapy with limited toxicity. As this technique has evolved, several small prospective studies and single institutional reviews have been published . These results show promise in terms of local control and overall survival, especially considering the limited treatment options available for most of the patients receiving SBRT.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiation therapy for hepatocellular carcinoma: Practice patterns, dose selection and factors impacting survival

et al. 2019

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Background Stereotactic body radiation therapy (SBRT) is an emerging option for unresectable hepatocellular carcinoma (HCC) without consensus regarding optimal dose schemas. This analysis identifies practice patterns and factors that influence dose selection and overall survival, with particular emphasis on dose and tumor size. Materials/Methods Query of the National Cancer Database (NCDB) identified patients with unresectable, nonmetastatic HCC who received SBRT from 2004 to 2013. Biological Effective Dose (BED) was calculated for each patient in order to uniformly analyze different fractionation regimens. Results A total of 456 patients met the inclusion criteria. The median BED was 100 Gy (22.5‐208.0), which corresponded to the most common dose fractionation (50 Gy in five fractions). Various factors influenced dose selection including tumor size (P < 0.001), tumor stage (P = 0.002), and facility case volume (<0.001). On multivariate analysis, low BED (<75 Gy, HR 2.537, P < 0.001; 75‐100 Gy, HR 1.986, P = 0.007), increasing tumor size (HR 1.067, P = 0.032), elevated AFP (HR 1.585, P = 0.019), stage 3 (HR 1.962, P < 0.001), low‐volume facilities (1‐5 cases HR 1.687, P = 0.006), and a longer time interval from diagnosis to SBRT (>2 to ≤4 months, HR 1.456, P = 0.048; >4 months, HR 2.192, P < 0.001) were associated with worse survival. Conclusion SBRT use is increasing for HCC, and multiple regimens are clinically employed. Although high BED was associated with improved outcomes, multiple factors contributed to the dose selection with favorable patients receiving higher doses. Continued efforts to enhance radiation planning and delivery may help improve utilization, safety, and efficacy.

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Section: Introductionmentioning

confidence: 99%

Stereotactic body radiation therapy for hepatocellular carcinoma: Practice patterns, dose selection and factors impacting survival

et al. 2019

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“…However, the role of radiation therapy for HCC management in the modern era has shifted from palliative to curative with encouraging results and minimum or no liver toxicity. The options for external radiotherapy techniques includes a wide array of 3D conformal radiotherapy (3DCRT), Intensity Modulated Radiotherapy (IMRT), SBRT, Charged Particle Radiotherapy, Trans-Arterial RadioEmbolization (TARE) or Brachytherapy using iodine seeds with local tumour control of 75-100%, one year survival of 55-75% and severe toxicity were reported in up to 30-40% [9,10]. The role of interstitial radiotherapy has been an area of active research in last two decades.…”

Section: Discussionmentioning

confidence: 99%

Image guided robotic interstitial brachytherapy, a new innovative treatment for malignancies

Vishwanathan¹,

Mandal²,

Kumar³

et al. 2018

Hematol Med Oncol

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Introduction: The evolution of brachytherapy has been refined over years, but many of the techniques remain unchanged. The limited utilisation of brachytherapy in comparison to conformal external radiotherapy may be due to its invasive approach, operative risk, technical challenge, time consuming, long learning curve and poor technological advancements. However, there is growing evidence for practicing hypo-fractionated regimes in many solid malignancies. The present article focus on the similar roles of image guided -robotic interstitial high dose rate brachytherapy with hepatocellular carcinoma (HCC) as prototype.

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“…Kimura et al reported the incidence of grade 3 or higher toxicities was higher in patients with Child–Turcotte–Pugh (CTP) class B than in patients with CTP class A disease ( P = 0.01) . Lasley et al showed that 11% of patients with Child–Pugh class (CPC)‐A disease and 38% of patients with CPC‐B disease had experienced grade 3/4 liver toxicity . These results suggest there was no significant deterioration of SBRT with age, but for patients with advanced liver dysfunction, such as those with CPC‐B disease, we should pay attention to liver injury.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of stereotactic body radiotherapy for elderly patients with hepatocellular carcinoma

Teraoka

Kimura

Aikata

et al. 2017

Hepatology Research

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Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy

Cited by 165 publications

References 11 publications

Stereotactic body radiation therapy for hepatocellular carcinoma: Practice patterns, dose selection and factors impacting survival

Stereotactic body radiation therapy for hepatocellular carcinoma: Practice patterns, dose selection and factors impacting survival

Image guided robotic interstitial brachytherapy, a new innovative treatment for malignancies

Clinical outcomes of stereotactic body radiotherapy for elderly patients with hepatocellular carcinoma

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