194 Hepatocellular cancers treated by radiation and chemotherapy combinations: toxicity and response: A radiation therapy oncology group study

Stillwagon, Gary B.; Order, Stanley E.; Guse, Clare E.; Klein, Jerry L.; Leichner, Peter K.; Leibel, Steven A.; Fishman, Elliott K.

doi:10.1016/0360-3016(89)90530-0

Cited by 90 publications

(51 citation statements)

References 26 publications

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“…35,36 In a prospective study by the Radiation Therapy Oncology Group, hyperfractionated whole-liver irradiation of 24 Gy in 1.2-Gy fractions twice daily for HCC failed to improve the response rate but increased the incidence of acute toxicities significantly. 37 The objective response rate of HCC to doses Ͻ 40 Gy in conventional fractions was Ͻ 30%, and doses Ն 50 Gy were necessary to reduce tumor volume and prolong survival significantly in patients with unresectable HCC. 38,39 Some studies demonstrated that the radiation tolerance of the liver was affected strongly by the irradiated volume of the liver; for instance, the doses associated with a 5% risk of radiation-induced liver disease for irradiation volumes of one-third and two-thirds were 90 Gy and 47 Gy, respectively.…”

Section: Discussionmentioning

confidence: 99%

Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Hata

Tokuuye

Sugahara

et al. 2005

Cancer

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BACKGROUNDTreatment modalities for patients with hepatocellular carcinoma (HCC) who have portal vein tumor thrombus (PVTT) are limited and controversial; furthermore, the prognosis for these patients is extremely poor. The authors conducted a retrospective review to determine the role of proton beam therapy in the treatment of patients who had HCC with PVTT.METHODSTwelve patients with HCC who had tumor thrombus in the main trunk or major branches of the portal vein (clinical T3–T4N0M0) were treated with proton beam therapy. At the time they received proton beam irradiation, patients ranged in age from 42 years to 80 years (median, 62 years), and their tumors ranged in size from 40 mm to 110 mm (median, 60 mm) in greatest dimension. A total dose of 50–72 gray (Gy) (median, 55 Gy) in 10–22 fractions was delivered to the tumors, including PVTT.RESULTSAll tumors that were treated with proton beam therapy remained controlled at a median follow‐up of 2.3 years (range, 0.3–7.3 years). Among 12 patients, 10 patients had new liver tumors outside the irradiated volume 0.1–2.4 years after proton beam therapy, and 3 patients also had distant metastases; consequently, 8 patients died of disease, and 2 patients were salvaged by further therapies. The remaining two patients were alive with no evidence of disease 4.3 years and 6.4 years after proton beam therapy. The progression‐free survival rates were 67% at 2 years and 24% at 5 years. The median progression‐free survival was 2.3 years. According to the Acute Radiation Morbidity Scoring Criteria (Radiation Therapy Oncology Group), therapy‐related toxicity ≥ Grade 3 was not observed.CONCLUSIONSProton beam therapy for patients with HCC who had PVTT was feasible and effective. It appeared to improve survival and local control significantly for these patients. Cancer 2005. © 2005 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Hata

Tokuuye

Sugahara

et al. 2005

Cancer

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“…At the time of this trial, localization of tumors in the liver was unsophisticated and in some cases impossible, moreover an inadequate dose regimen of 21 Gy in 7 fractions was utilized (17). In the 1980s, trials were developed for primary HCC specifically to test the viability of this regimen and other hyperfractionated approaches when combined with radiosensitizing chemotherapy (18). Although these techniques were reasonably well tolerated, the efficacy was generally dismal with low doses of radiation, and even with various fractionation schemes and concomitant therapy, local control and survival remained poor (19).…”

Section: Historical Experience With Liver Radiotherapymentioning

confidence: 99%

Radiation therapy for hepatobiliary malignancies

Lischalk

Repka

Unger

2017

J. Gastrointest. Oncol.

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“…Dans une é tude ré trospective portant sur 356 patients atteints de CHC localement avancé s, le taux de ré ponse objective n'é tait en effet que de 13,6 %, et la survie à un et cinq ans de respectivement 35,6 et 0 % [30]. Ces mauvais ré sultats é taient lié s à la technique d'irradiation, avec un champ englobant la totalité ou une grande partie du parenchyme hé patique, ne permettant de dé livrer que de faibles doses (8 à 32 Gy ; 24 Gy en moyenne), trop faible pour espé -rer sté riliser les lé sions de CHC [28]. Né anmoins, le CHC s'é tait avé ré objectivement radiosensible dans plusieurs é tudes pré liminaires utilisant une radiothé rapie mé tabolique in situ par injection intravasculaire d'antiferritine conjugué e à de l'iode 131, é vitant ainsi les complications hé patiques gé né rales.…”

Section: Place De La Radiothé Rapie Externeunclassified

Place de la radiothérapie dans la stratégie de traitement du carcinome hépatocellulaire

et al. 2007

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Ré sumé : Le traitement du carcinome hé patocellulaire chez le patient cirrhotique reste mal codifié . Les moyens thé rapeutiques reconnus comme potentiellement curatifs sont la transplantation hé patique, la ré section chirurgicale et les destructions radiologiques percutané es, mais ne sont possibles que lorsqu'ils s'adressent à des patients porteurs de CHC de petite taille. La radiothé rapie de conformation (RTC), qui permet de dé livrer de fortes doses d'irradiation sur le site tumoral en é pargnant le reste du foie adjacent, a ré cemment é té introduite dans cette indication. Plusieurs é tudes ont montré que la RTC permet d'obtenir des taux de ré ponses objectives trè s encourageants, mê me pour les CHC de grande taille. L'avantage de la RTC ré side dans le fait qu'il s'agit d'une technique non invasive, sans contrainte de faisabilité en fonction de la topographie de la tumeur au sein du parenchyme hé patique ni de l'é tat gé né ral du patient ou des comorbidités. L'impact de la RTC doit ê tre mieux é valué au cours d'é tudes contrô lé es et randomisé es afin de mieux dé finir sa place dans l'arsenal thé rapeutique du CHC.Mots clé s : Carcinome hé patocellulaire -Chirurgie -Chimiothé rapieAsservissement respiratoireRadiothé rapieThe appropriate place of radiotherapy in the therapeutic strategy for hepatocellular carcinoma Abstract: The optimal therapeutic strategy for hepatocellular carcinoma (HCC) in patients with cirrhosis remains elusive. Potentially curative treatments include liver transplantation, surgical resection and percutaneous ablation, but they are only feasible when HCC is limited in size. Conformal radiation therapy (CRT) is a recent advance in radiotherapy allowing the tumour site to receive higher radiation doses by targeting tumour volume and decreasing the exposure of normal liver. CRT has been shown to result in high local control rates in HCC patients. In cirrhotic patients, it is associated with a number of important characteristics: it is noninvasive, has the ability to target any site within the liver parenchyma, and has no contraindication regarding medical condition. Yet the impact of CRT must be evaluated in randomized trials for better integration into HCC therapeutic options.Le carcinome hé patocellulaire (CHC) est une tumeur maligne fré -quente qui se dé veloppe le plus souvent sur un foie cirrhotique. Son incidence est en augmentation dans toutes les ré gions du globe, avec cependant des diffé rences gé ographiques selon les facteurs é tiologiques associé s : le virus de l'hé patite B en Afrique et en Asie, l'aflatoxine B1 en Afrique, le virus de l'hé patite C et la consommation alcoolique de faç on ubiquitaire [9]. Les traitements sont dé cevants et le pronostic des patients est gé né -ralement dé favorable (mé diane de survie infé rieure à 18 mois), du fait d'une é volution tumorale importante dè s le diagnostic dans prè s de 80 % des cas, rendant seul un traitement palliatif envisageable. Lorsque le CHC est diagnostiqué à un stade plus pré coce (20 % des patients), la ré sec...

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194 Hepatocellular cancers treated by radiation and chemotherapy combinations: toxicity and response: A radiation therapy oncology group study

Cited by 90 publications

References 26 publications

Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Radiation therapy for hepatobiliary malignancies

Place de la radiothérapie dans la stratégie de traitement du carcinome hépatocellulaire

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