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

Teraoka, Yuji; Kimura, Tomoki; Aikata, Hiroshi; Daijo, Kana; Osawa, Mitsutaka; Honda, Fumi; Nakamura, Yuki; Morio, Kei; Morio, Reona; Hatooka, Masahiro; Kobayashi, Tomoki; Nakahara, Takashi; Murakami, Eisuke; Nagaoki, Yuko; Kawaoka, Tomokazu; Tsuge, Masataka; Hiramatsu, Akira; Imamura, Michio; Kawakami, Yoshiiku; Nagata, Yasushi; Chayama, Kazuaki

doi:10.1111/hepr.12916

Cited by 18 publications

(17 citation statements)

References 29 publications

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“…Stereotactic body radiation therapy and proton beam therapy have also demonstrated efficacy in HCC, and early results suggest outcomes equivalent to those of TACE with a reduced adverse-effect profile [168][169][170][171][172][173][174][175] . However, high-quality data on stereotactic body radiation therapy and proton beam therapy are lacking and additional studies are needed to define the optimal treatment selection process for locoregional therapy.…”

Section: Transarterial Embolization and Radiotherapymentioning

confidence: 99%

A global view of hepatocellular carcinoma: trends, risk, prevention and management

Yang

Hainaut

Gores

et al. 2019

Nat Rev Gastroenterol Hepatol

3,112

2,365

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Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. Risk factors for HCC include chronic hepatitis B and hepatitis C, alcohol addiction, metabolic liver disease (particularly nonalcoholic fatty liver disease) and exposure to dietary toxins such as aflatoxins and aristolochic acid. All these risk factors are potentially preventable, highlighting the considerable potential of risk prevention for decreasing the global burden of HCC. HCC surveillance and early detection increase the chance of potentially curative treatment; however, HCC surveillance is substantially underutilized, even in countries with sufficient medical resources. Early-stage HCC can be treated curatively by local ablation, surgical resection or liver transplantation. Treatment selection depends on tumour characteristics, the severity of underlying liver dysfunction, age, other medical comorbidities, and available medical resources and local expertise. Catheter-based locoregional treatment is used in patients with intermediate-stage cancer. Kinase and immune checkpoint inhibitors have been shown to be effective treatment options in patients with advanced-stage HCC. Together, rational deployment of prevention, attainment of global goals for viral hepatitis eradication, and improvements in HCC surveillance and therapy hold promise for achieving a substantial reduction in the worldwide HCC burden within the next few decades.

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Section: Transarterial Embolization and Radiotherapymentioning

confidence: 99%

A global view of hepatocellular carcinoma: trends, risk, prevention and management

Yang

Hainaut

Gores

et al. 2019

Nat Rev Gastroenterol Hepatol

3,112

2,365

View full text Add to dashboard Cite

show abstract

“…Classic photon radiation therapy has rarely been used in HCC because the dose tolerance of normal liver tissue is considerably lower than that necessary for tumor control. Recently, highly conformal radiotherapy, such as stereotactic body radiation therapy (SBRT), has been reported to achieve good control for small HCCs with a tolerable liver dose [ 6 , 7 ]. However, for larger HCCs, photon therapy cannot easily provide adequate coverage of the target without increasing the risk of radiation-induced liver disease [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas

Shibata

Takamatsu

Yamamoto

et al. 2018

Cancers

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We evaluated the effectiveness and toxicity of proton beam therapy (PBT) for hepatocellular carcinomas (HCC) >5 cm without fiducial markers using four-dimensional CT (4D-CT) planning. The subjects were 29 patients treated at our hospital between March 2011 and March 2015. The median total dose was 76 Cobalt Gray Equivalents (CGE) in 20 fractions (range; 66–80.5 CGE in 10–32 fractions). Therapy was delivered with end-expiratory phase gating. An internal target volume (ITV) margin was added through the analysis of respiratory movement with 4D-CT. Patient age ranged from 38 to 87 years (median, 71 years). Twenty-four patients were Child–Pugh class A and five patients were class B. Tumor size ranged from 5.0 to 13.9 cm (median, 6.9 cm). The follow-up period ranged from 2 to 72 months (median; 27 months). All patients completed PBT according to the treatment protocol without grade 4 (CTCAE v4.03 (draft v5.0)) or higher adverse effects. The two-year local tumor control (LTC), progression-free survival (PFS), and overall survival (OS) rates were 95%, 22%, and 61%, respectively. The LTC was not inferior to that of previous reports using fiducial markers. Respiratory-gated PBT with 4D-CT planning without fiducial markers is a less invasive and equally effective treatment for large HCCs as PBT with fiducial markers.

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“…[21][22][23] For patients with newly diagnosed and recurrent small liver cancer, a large number of recent studies have shown that the local control rate and overall survival rate of SBRT and radical surgery are similar. [24][25][26][27][28][29] The main limitations of conventional SBRT for liver malignancies are dislocation of the treatment target caused by respiratory movement and acute radiation damage to the liver at low and medium levels. Therefore, how to make SBRT with more accurate image guidance technology is the goal constantly pursued in the era of precision radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…The overall local control rate can reach 80% to 100%, and the 3‐year survival rate can reach 54% to 70.0% 21‐23 . For patients with newly diagnosed and recurrent small liver cancer, a large number of recent studies have shown that the local control rate and overall survival rate of SBRT and radical surgery are similar 24‐29 . The main limitations of conventional SBRT for liver malignancies are dislocation of the treatment target caused by respiratory movement and acute radiation damage to the liver at low and medium levels.…”

Section: Discussionmentioning

confidence: 99%

CT‐guided liver beacon transponder implantation

Zhang

Guo

et al. 2021

Precision Medical Sciences

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Objective: To investigate the method of CT-guided beacon transponder implantation and precautions after implantation for liver malignant tumor. Methods: CT-guided beacon transponder implantation in three patients with liver malignancies was the first time in China. The operations were performed using Siemens's 16-row large-aperture spiral CT and 17-G guide needles were using for percutaneous liver puncture. Results: All three operations were successfully completed. During the operations, the beacon transponders were successfully implanted at predetermined targets next to the lesion in the liver parenchyma, and there was no obvious bleeding, pain or discomfort. All patients underwent localized CT examination on the fifth day after operations. Only one beacon transponder moved slightly, the remaining eight beacon transponders did not move, and the CT images did not have obvious metal artifacts. After the completion of radiotherapy in three patients, the follow-up CT examination showed no movement of the beacon transponders, and the liver lesions shrank well. However, 3.0 T MRI of the liver showed that the magnetic sensitive artifacts at beacon transponders were more obvious, which affected the observation of local liver tissue. Conclusion: CT-guided liver beacon transponder implantation is safe and feasible. Beacon transponders may move in the liver parenchyma within a short period of time after implantation. Therefore, localized CT examination is recommended to be performed 4 days after the implantation. CT scans after beacon transponder implantation have no obvious metal artifacts. So CT is recommended for follow-up. However, magnetic resonance sensitive artifacts are more obvious when MRI is performed, which will affect the evaluation of local efficacy and detect new small lesions.

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

Abstract: Stereotactic body radiotherapy can be effective and safe for the treatment of HCC in elderly patients.

Cited by 18 publications

References 29 publications

A global view of hepatocellular carcinoma: trends, risk, prevention and management

A global view of hepatocellular carcinoma: trends, risk, prevention and management

Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas

CT‐guided liver beacon transponder implantation

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