Acceptable Toxicity After Stereotactic Body Radiation Therapy for Liver Tumors Adjacent to the Central Biliary System

Eriguchi, Takahisa; Takeda, Atsuya; Sanuki, Naoko; Oku, Yohei; Aoki, Yousuke; Shigematsu, Naoyuki; Kunieda, Etsuo

doi:10.1016/j.ijrobp.2012.09.012

Cited by 72 publications

(52 citation statements)

References 16 publications

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“…As showed in the literature, SBRT can be safely delivered to tumors located within or near the biliary system (Eriguchi et al 2013); indeed, in our series biliary toxicity was not detected.…”

Section: Discussionsupporting

confidence: 80%

The challenge of inoperable hepatocellular carcinoma (HCC): results of a single-institutional experience on stereotactic body radiation therapy (SBRT)

Scorsetti

Comito

Cozzi

et al. 2015

J Cancer Res Clin Oncol

145

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Section: Discussionsupporting

confidence: 80%

The challenge of inoperable hepatocellular carcinoma (HCC): results of a single-institutional experience on stereotactic body radiation therapy (SBRT)

Scorsetti

Comito

Cozzi

et al. 2015

J Cancer Res Clin Oncol

145

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“…52 It should also pay special attention to centrally located hepatic lesions where the central biliary system is a serially functioning organ. 58,59 In conclusion, a prudent approach, is to use dosevolume constraints for organs at risk summarized in updated guidelines 2,54 or determined in high-quality phase I trials. 16 …”

Section: Dose-volume Constraints For Organs At Riskmentioning

confidence: 99%

Radiobiology of stereotactic body radiation therapy (SBRT)

Garau

2017

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tRecent advances in the technology of radiotherapy have enabled the development of new therapeutic modalities that deliver radiation with very high accuracy, reduced margins and high dose conformation, allowing the reduction of healthy tissue irradiated and therefore minimizing the risk of toxicity. The next step was to increase the total tumor dose using conventional fractionation (which remains the best way to relatively radioprotect healthy tissues when large volumes are treated) or to use new fractionation schemes with greater biological effectiveness. Based on the experience gained in radiosurgery, the latter way was chosen for small and well-defined tumors in the body. Stereotactic body radiotherapy delivers high doses of radiation to small and well-defined targets in an extreme hypofractionated (and accelerated) scheme with a very high biological effectiveness obtaining very good initial clinical results in terms of local tumor control and acceptable rate of late complications.In fact, we realize a posteriori that it was not feasible to administer such biologically equivalent dose in a conventional fractionation because the treatment could last several months.So far, these new therapeutic modalities have been developed due to technologic advances in image guidance and treatment delivery but without a solid biological basis. It is the role of traditional radiobiology (and molecular radiobiology) to explain the effects of high doses of ionizing radiation on tumor and normal tissues. Only through a better understanding of how high doses of ionizing radiation act, clinicians will know exactly what we do, allowing us in the future to refine our treatments. This article attempts to describe through simple and understandable concepts the known aspects of the biological action of high doses of radiation on tumor and normal tissues, but it is clear that we need much more basic research to better understand the biology of high doses of radiation.

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“…Sapisochin et al recently reported an intention to treat analysis about SBRT used as a bridging therapy in patient not eligible for other LRTs and observed similar drop-out rate with SBRT and RFA or TACE (30). It is proven to be a safe procedure for lesions <6 cm of diameter, even in those localized near the central biliary system, where surgery or ablation cannot be performed (31,32).…”

Section: Stereotactic Body Radiotherapy (Sbrt)mentioning

confidence: 99%

“…For lesions near the gallbladder or bowel, PEI seems to be safer than RFA. In the same way, SBRT is not indicated for lesions near the bowel, for his risk of bleeding and perforation (31). However, SBRT have the advantage to treat the lesions adjacent to the central biliary system, that are not suitable for LR or ablation.…”

Section: Sorafenibmentioning

confidence: 99%

Bridging patients with hepatocellular cancer waiting for liver transplant: all the patients are the same?

Coletta

Nicolini

Cacciaguerra

et al. 2017

Transl. Gastroenterol. Hepatol.

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Hepatocellular carcinoma (HCC) is the fifth more frequent cancer worldwide and the most common primary liver tumor. Liver transplant (LT) is considered the best curative treatment for patients with cirrhosis and HCC within Milan criteria (1 tumor ≤5 cm and up to 3 tumors ≤3 cm). It removes all the liver affected by cancer and at the same time it treats the underlying liver disease, with a survival rate of 70% and a 5 years recurrence rate of less than 20%. Unfortunately, the applicability of LT for HCC patients is limited by the shortage of liver grafts, determining a longer time on waitlist and high dropout rate. Bridging treatments are neo-adjuvant antitumoral therapies given to patients on the waitlist for LT, affected by HCC within the criteria, with the aim to reduce the disease progression and therefore the dropout rate. Indeed, these treatments act as a "bridge" until a suitable donor organ becomes available. Most of bridging therapies are locoregional treatments (LRTs). Dropout rate for HCC progression increases in a time-dependent way (1) and evidences show higher dropout rates in patients with tumor >3 cm and an expected waiting time longer than 3-6 months (2). In different reports, if HCC is left untreated, the risk of drop out at 6 months and at 1 year has been estimated to be respectively 12% and 15-30% (3,4). Risk factors for dropout include: tumor diameter greater than 3 cm or multifocal disease, serum α-fetoprotein (AFP) level greater than 200 ng/mL, waiting time longer than 6 months and lack of response to bridging therapy (5). Although there are no randomized control trials (RCT) evaluating the efficacy of neo-adjuvant therapies in reducing dropout rate and improving survival after LT, LRT is accepted as the standard of care for patients expected to stay on the waitlist for more than 6 months. In patients with HCC within Milan criteria, bridging therapy is estimated to reduce dropout rate to 0-10%. A retrospective study

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Acceptable Toxicity After Stereotactic Body Radiation Therapy for Liver Tumors Adjacent to the Central Biliary System

Cited by 72 publications

References 16 publications

The challenge of inoperable hepatocellular carcinoma (HCC): results of a single-institutional experience on stereotactic body radiation therapy (SBRT)

The challenge of inoperable hepatocellular carcinoma (HCC): results of a single-institutional experience on stereotactic body radiation therapy (SBRT)

Radiobiology of stereotactic body radiation therapy (SBRT)

Bridging patients with hepatocellular cancer waiting for liver transplant: all the patients are the same?

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