Advances in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Murray, Louise; Dawson, Laura A.

doi:10.1016/j.semradonc.2017.02.002

Cited by 82 publications

(76 citation statements)

References 55 publications

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“…Treatment fractionation is one of the factors for SBRT success allowing high doses to be delivered to the tumor during several iterations. 8 Dose escalation to the tumor is, however, accompanied by extensive irradiation of the surrounding healthy organs-at-risk (OARs), which may result in toxicities of OARs. Acute and late toxicities can manifest after up to 30% of liver SBRTs significantly compromising patients' life after the treatment and potentially increasing mortality rates.…”

Section: Introductionmentioning

confidence: 99%

Development of deep neural network for individualized hepatobiliary toxicity prediction after liver SBRT

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Development of deep neural network for individualized hepatobiliary toxicity prediction after liver SBRT

et al. 2018

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“…Radiation therapy has not traditionally been considered as a viable option for the treatment of HCC due to the sensitivity of the liver to radiation; however, advances in radiation technique (3D‐conformal, intensity‐modulated radiation therapy) and delivery (respiratory motion management, image guidance) have resulted in the development of stereotactic body radiation therapy (SBRT) . SBRT delivers high‐dose ablative radiation to precisely delineated targets with tight conformity and a steep dose falloff in a limited number of treatment sessions.…”

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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“…The consequence is the same as in our subgroup analysis. The treatment with TACE followed by SBRT was based on theoretical evidence that TACE can shrink the tumor size and kill the tumor cells in the first treatment, which can reduce the volume prior to SBRT and improve the efficiency of SBRT [33,34]. LCS and PFS in the ST and SA groups were not significantly different.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy Combined with Transcatheter Arterial Chemoembolization versus Stereotactic Body Radiotherapy Alone as the First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review

Zhao¹,

Zeng²,

Wu³

et al. 2019

Chemotherapy

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Background: The superiority of stereotactic body radiotherapy (SBRT) combined with transcatheter arterial chemoembolization (TACE) compared to SBRT alone as the first-line therapy for unresectable hepatocellular carcinoma (HCC) remains unclear. We conducted this meta-analysis to compare the efficiency and safety of SBRT combined with TACE (ST group) and SBRT alone (SA group). Methods: We searched PubMed, Ovid Medline, Web of Science, Scopus, The Cochrane Library, ScienceDirect, EMBASE, Google Scholar, and CNKI (China National Knowledge Infrastructure) for related studies. We analyzed overall survival (OS), local control survival (LCS), progression-free survival (PFS), the response rate and adverse effects (AEs) between the 2 groups. Results: Ten articles were included, with a total of 980 patients. The results showed that the ST (SBRT + TACE) group had a longer OS (95% CIs 0.60-0.85, p = 0.0002), a higher 5-year OS rate (95% CI 1.01-2.04, p = 0.04), a higher rate of complete response (95% CI 1.08-1.90, p = 0.01), and a higher disease control rate (95% CI 1.02-1.16, p = 0.02) than the SA (SBRT alone) group. No significant difference was found in LCS, PFS and total AEs of all grades and grades 3-5 AEs between the 2 groups. In the subgroup analysis, the patients with HCC + PVTT or treated with SBRT followed by TACE in the ST group had the same OS as those in the SA group, and the patients in the ST group had a higher incidence rate of leukopenia and fever than those in the SA group. Conclusion: SBRT + TACE appears to be more effective than SBRT alone in treating unresectable HCC. However, its higher incidence rate of leukopenia and fever need to be monitored. and PFS. When HRs with 95% CIs were < 1, the result supports the superiority of ST. We extracted HR data directly from Buckstein et al. [21]. We extracted data from Kaplan-Meier curves using methods described by Tierney et al. [22]. Risk ratios with 95% CI were used to analyze the dichotomous variables (response rates, AEs). We conducted subgroup analyses of OS, LCS, and PFS to determine whether the results changed according to nation, patient type, treatment priority, tumor stage, Child-Pugh class, and Eastern Cooperative Oncology Group (ECOG) performance status. Heterogeneity was evaluated using the I 2 statistic and χ 2 test. If I 2 was > 50% or p was < 0.1, the fixed effects model was used, reflecting the lack of significant heterogeneity; otherwise, we used the random effects model. The sensitivity analysis in this study was performed with STATA. Begg's rank correlation and Egger's linear regression tests were used to evaluate the publication bias. Statistical significance existed when p was < 0.05.

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Advances in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Cited by 82 publications

References 55 publications

Development of deep neural network for individualized hepatobiliary toxicity prediction after liver SBRT

Development of deep neural network for individualized hepatobiliary toxicity prediction after liver SBRT

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

Stereotactic Body Radiotherapy Combined with Transcatheter Arterial Chemoembolization versus Stereotactic Body Radiotherapy Alone as the First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review

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