Comparison of Combination Stereotactic Body Radiotherapy Plus High-Intensity Focused Ultrasound Ablation Versus Stereotactic Body Radiotherapy Alone for Massive Hepatocellular Carcinoma

Abstract

BackgroundThermal high-intensity focused ultrasound ablation is a non-invasive treatment of massive hepatocellular carcinomas. In stereotactic body radiotherapy, ablative radiotherapy is administered to tumors in targeted, limited doses to minimize damage to nearby tissues. We evaluated the outcomes and survival of patients receiving stereotactic body radiotherapy (singular therapy) versus those receiving combination thermal high-intensity focused ultrasound ablation plus stereotactic body radiotherapy (combination therapy).Material/MethodsWe compared data of 160 patients with massive hepatocellular carcinomas (12.5–18 cm) who were treated with combination therapy to those treated with singular therapy between January 2009 and February 2016.ResultsEighty-four patients were treated with single therapy while 76 were treated with combination therapy. Comparison of short-term outcomes and long-term survival between the groups revealed no significant differences in adverse events. In the combination group, the proportions of patients with complete response, partial response, stable disease, and progressive disease were 52.6%, 21.1%, 21.1%, and 5.3%, respectively; in the single therapy group, the corresponding rates were 0%, 23.8%, 50%, and 26.2%, respectively (P<0.0001). The 1-year, 3-year, and 5-year survival rates in the combination group were 33%, 20%, and 13%, respectively, while those in the single therapy group were 21%, 14%, and 1%, respectively. These data indicated no differences in complications between the groups except for a significantly higher level of skin edema in the combination group (P=0.015).ConclusionsCombination therapy is more effective than single therapy for the treatment of massive hepatocellular carcinomas, although rates of most complications appear to be similar.

Evaluation of a Developed MRI-Guided Focused Ultrasound System in 7 T Small Animal MRI and Proof-of-Concept in a Prostate Cancer Xenograft Model to Improve Radiation Therapy

“…Similarly, Liu et al [34] reported that a combined treatment of FUS-ablation and RT is more effective for the induction of injury in the swine pancreas compared to a single treatment. In addition, clinical evidence showed that the combination of HIFU ablation and stereotactic body radiation therapy increases the treatment efficiency in massive hepatocellular carcinomas and that the survival rates of patients were significantly enhanced compared to single treatment [35]. The future perspective of using FUS heating as an adjuvant to radiotherapy includes the idea of being able to reduce the radiation dose compared to radiation alone, e.g., only half or one-third to achieve the same effects with fewer side effects, or to have the option to re-irradiate.…”

Prognostic Significance of Tumor Growth Rate (TGR) in Patients with Huge Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

“…They found significantly better OS results in those receiving the combined treatment than in those receiving TACE alone. A study showed that the one-year survival rate in the ablation plus stereotactic body radiotherapy (SBRT) cohort was 87%, which was overmatched in the SBRT-only group [ 21 ]. Another study demonstrated that TACE following percutaneous microwave coagulation therapy in HHCC patients was an ideal treatment strategy.…”

High-Intensity Focused Ultrasound Ablation for Unresectable Primary and Metastatic Liver Cancer: Real-World Research in a Chinese Tertiary Center With 275 Cases

“…As a summary of previous studies ( Table 5), HIFU has commonly been used for HCC as monotherapy (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) or in combination with other therapies, such as TACE (34)(35)(36)(37)(38)(39)(40)(41)(42), cryocare knife (65), and SBRT (63,66). However, very few studies have reported the efficacy of HIFU monotherapy in patients with MLC (20, 24, 43-47) without any HIFU-based combination regimens reported.…”