Analysis of the factors affecting the safety of robotic stereotactic body radiation therapy for hepatocellular carcinoma patients

Liu, Xiao Jie; Song, Yong; Liang, Ping; Su, Ting; Zhang, Huo Jun; Zhao, Xian Zhi; Yuan, Zhi Yong; Wang, Ping

doi:10.2147/ott.s142025

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…The radiosensitivity of hepatocellular carcinoma, a primary malignancy of the liver, makes it a suitable candidate for hypofractionated radiation treatments [7]. Many multi-center studies have evaluated the outcomes of liver SBRT using a variety of treatment techniques [8][9][10][11][12][13][14]. Stereotactic body radiation therapy (SBRT) by the CyberKnife V R (Accuray Inc., USA) using Synchrony V R respiratory motion compensation is a promising technique to treat liver cancer, especially for patients who are not eligible for radio-frequency ablation or surgical resection [15].…”

Section: Introductionmentioning

confidence: 99%

Geometrical tracking accuracy and appropriate PTV margins for robotic radiosurgery of liver lesions by SBRT

2019

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Purpose: To assess the geometrical accuracy and estimate adequate PTV margins for liver treatments using the Synchrony respiratory tracking system. Material and methods: Treatment log files are analyzed for 72 liver patients to assess tracking accuracy. The tracking error is calculated as the quadratic sum of the correlation, the predictor and the beam positioning errors. Treatment target rotations and rigid body errors reported by the system are also evaluated. The impact of uncorrected rotations is assessed by rotating the planned dose distribution and reassessing target coverage. Total PTV margins are estimated by summing in quadrature tracking errors and rigid body errors. Relationships are explored between tracking errors, model linearity and motion amplitudes of internal and external markers. Results: Margins of 3, 2, 2 mm in SUP-INF, LT-RT and ANT-POST directions, respectively, are sufficient to account for tracking and beam positioning errors for 95% of patients. If rigid body error is also considered, margins increase to 4 mm isotropic. Rotations could not be corrected for 92% of patients due to imperfect fiducial implantation and limitations in the magnitude of corrections that the system can apply. Uncorrected rotations would lead to average estimated dose reductions of 2.7% ± 5.8% of the prescribed dose for D99 of GTVs (5 mm PTV expansion) in which the target was well covered in the original plan (28 of 31 GTVs). 80% of tracking models exhibit near linear correlation between internal and external marker motions with small tracking errors (<2.2 mm). Conclusions: Isotropic PTV margins considering tracking errors and target rigid body errors could be used for liver SBRT treatments if rotational corrections can be calculated accurately so that systematic rotational offsets can be avoided. The linearity of the internal and external breathing motions might be useful for other types of treatment modalities for liver cancer.

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Section: Introductionmentioning

confidence: 99%

Geometrical tracking accuracy and appropriate PTV margins for robotic radiosurgery of liver lesions by SBRT

2019

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Section: Discussionmentioning

confidence: 99%

“…Thirteen patients presented with grade ≥2 hepatic adverse reaction and 8 patients presented with decreases in CP classification. Total liver volume >1,162 mL and normal liver volume >1,148 mL should be ensured to improve therapeutic safety [24]. Additionally, another fractionated scheme of 39–50 Gy in 3–5 fractions were applied in our single-institutional Phase II trial of SBRT for the treatment of HCC in patients with 1–3 nodular HCC lesions with a total diameter <10 cm (ChiCTR-IIC-16008233).…”

Section: Discussionmentioning

confidence: 99%

Optimal Stereotactic Body Radiotherapy Dosage For Hepatocellular Carcinoma

Zhou

Huang

et al. 2020

Preprint

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Background and purpose: The optimal dose and fractionation scheme of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) remains unclear due to different tolerated liver volumes and degrees of cirrhosis. We compared the effectiveness of stereotactic body radiation therapy dosing regimens for hepatocellular carcinoma (HCC). Methods and materials: This single-center retrospective study included 604 patients treated during 2011-2017. Biologically effective dose (BED10) and equivalent dose in 2 Gym fractions (EQD2) were assumed at an α/β ratio of 10. Overall survival (OS), local recurrence-free rate (LRF), intrahepatic recurrence-free rate (IRF), and progression-free survival (PFS) was evaluated in univariable and propensity-score matched analyses. Results: Median tumor size was 5.2 cm (interquartile range [IQR], 1.1-21.0). Median follow-up was 31 months in surviving patients (IQR, 3-82). High radiotherapy dose correlated with better OS, PFS, LRF and IRF. Different post-SBRT OS, PFS, LRF and IRF rates were observed for stereotactic ablative radiotherapy (SART) with BED10 ≥100 Gy, SBRT with EQD2 ≥74 Gy to BED10 <100 Gy, and stereotactic conservative radiotherapy (SCRT) with EQD2 <74 Gy. Conclusions: High radiotherapy dose correlated with better outcomes. If tolerated by normal tissue, we recommend SART as a first-line ablative dose or SBRT as a second-line radical dose. Otherwise, SCRT is recommended as palliative irradiation.

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Albumin–bilirubin score is a useful predictor of worsening liver reserve after stereotactic body radiation therapy in elderly Japanese patients with hepatocellular carcinoma

Yoshino,

Suzuki,

Shiomi

et al. 2024

Journal of Radiation Research

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The prognosis of patients with hepatocellular carcinoma (HCC) is closely related to their liver reserves. The Child-Pugh (CP) score has traditionally been used to evaluate this reserve, with CP Grade B (CP score ≥ 7) associated with a higher risk of radiation-induced liver disease after stereotactic body radiation therapy (SBRT). However, the CP score has limitations, as it does not accurately assess liver reserve capacity. The albumin–bilirubin (ALBI) score has been introduced as a meticulous indicator of liver reserve for the treatment of HCC. We retrospectively evaluated the role of the ALBI score in estimating the worsening liver reserve in 42 patients with HCC treated with SBRT using CyberKnife between 2015 and 2023. The median biologically effective dose (α/β = 10 Gy) was 100 Gy. For a median follow-up duration of 17.4 months, the 1-year overall survival (OS), local control (LC) and progression-free survival (PFS) rates were 100, 98 and 62%, respectively. Worsening liver reserve was defined as an increase in the modified ALBI grade or CP score within 1 year after SBRT. Univariate and multivariate analyses showed that the baseline ALBI score (≥−2.7 vs <−2.7) was the only significantly different predictor of worsening liver reserve. The OS and LC rates after SBRT for HCC were satisfactory. However, the PFS was poor, and recurrent HCC will require additional treatment. It is clinically important to predict the liver reserve capacity after SBRT, and the baseline ALBI score is a useful predictor.

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Analysis of the factors affecting the safety of robotic stereotactic body radiation therapy for hepatocellular carcinoma patients

Cited by 6 publications

References 25 publications

Geometrical tracking accuracy and appropriate PTV margins for robotic radiosurgery of liver lesions by SBRT

Geometrical tracking accuracy and appropriate PTV margins for robotic radiosurgery of liver lesions by SBRT

Optimal Stereotactic Body Radiotherapy Dosage For Hepatocellular Carcinoma

Albumin–bilirubin score is a useful predictor of worsening liver reserve after stereotactic body radiation therapy in elderly Japanese patients with hepatocellular carcinoma

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