Effectiveness and feasibility of external beam radiotherapy for hepatocellular carcinoma with inferior vena cava and/or right atrium involvement: a multicenter trial in Korea (KROG 17-10)

Rim, Chai Hong; Jeong, Bae Kwon; Kim, Tae Hyun; Kim, Jin Hee; Kang, Hyeyoung; Seong, Jinsil

doi:10.1080/09553002.2020.1721607

Cited by 16 publications

(31 citation statements)

References 26 publications

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“…Lastly, the most common sites of first progression after local control using EBRT were the liver (43.2%) and lung (34.0%), as expected. In the multi-institutional study by Rim et al [36], which is All rights reserved. No reuse allowed without permission.…”

Section: Discussionmentioning

confidence: 99%

“…Among the 18 studies, 8 were single arm studies [19][20][21][22][31][32][33][34] that were categorized into the surgery subgroup, another 8 were single arm studies [24,[35][36][37][38][39][40][41] categorized into the EBRT subgroup, and 2 were controlled studies [42,43] comprising 2 cohorts that compared surgery and EBRT. Eight studies (44%) were from mainland China, 6 from Japan (33%), 2 from Korea (11%), and 1 from Taiwan All rights reserved.…”

Section: Study Inclusion and General Informationmentioning

confidence: 99%

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Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta-analysis

Lee

Park

Seo

et al. 2020

Preprint

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Purpose: As the treatment efficacy of systemic therapy for patients with advanced stage HCC is insufficient, locoregional therapies are performed in the clinical practice. We investigated the efficacy and safety of two most potent therapies, surgery and external beam radiotherapy (EBRT), in patients with HCC involving the IVC and/or right atrium (RA) through comparative meta-analysis. Method: A systematic search of Pubmed, MEDLINE, EMBASE, and the Cochrane library was performed for entries up to July 2020. The primary endpoints were 1 and 2 year overall survival (OS) rates, while secondary endpoints were response rate, local control rate, and grade >=3 toxicities. Results: Eighteen studies with 22 cohorts were included, encompassing 755 patients. The pooled median OS and 1 and 2 year OS rates were 14.2 months, 55.6%, and 27.4%, respectively. The pooled median OS in the surgery and EBRT arms were 15.3 and 11.7 months, respectively. The pooled 1 year OS rate of the surgery arm was significantly higher than that of the EBRT arm (62.4%, 95% CI: 53.8–70.3 vs. 48.8%, 95% CI: 40.9–56.8; p=0.023). However, the 2 year OS rates were comparable (26.9%, 95% CI: 20.7–34.2 vs. 27.5%, 95% CI: 19.7–37.1; p=0.913). The pooled response and local control rates in the EBRT arm were 74.3% and 87.2%, respectively. In the surgical arm, the perioperative mortality and grade >=3 complication rates were 0–7.6% and 3.9–67%, respectively. Grade >=3 complications and radiation induced liver disease were rarely observed in the EBRT arm. Conclusions: Both surgery and EBRT are effective treatment options for patients with HCC involving IVC/RA invasion. Outcomes and safety should be further evaluated in well-controlled clinical trials.

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Section: Discussionmentioning

confidence: 99%

Section: Study Inclusion and General Informationmentioning

confidence: 99%

Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta-analysis

Lee

Park

Seo

et al. 2020

Preprint

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“…While the above studies were performed before the sorafenib era in 2008, 16 several others have reported more recent outcomes. Rim et al 11 performed a multiinstitutional study registered as the Korean Radiation Oncology Group trial (KROG 17-10), to investigate the use of EBRT for HCC patients with IVC and/or RA thrombosis. Forty-nine patients who underwent EBRT during 2003-2017 at 6 institutions were recruited; the median survival was 10.1 months, while the 1-and 2-year survival rates were 43.5% and 30.1%, respectively.…”

Section: Dovepressmentioning

confidence: 99%

“…Our team has previously published a clinical metaanalysis of EBRT studies on HCC patients with IVC and/ or RA thromboses. 11 We also recently performed an updated meta-analysis of 18 studies involving 22 cohorts comparing EBRT with surgery. 25 Each cohort included at least 10 relevant patients, with the entire study including 755 patients.…”

Section: Dovepressmentioning

confidence: 99%

“…In addition, there have been concerns that administration of local treatment to patients with IVC and/or RA thrombosis might result in serious systemic complications such as pulmonary embolism or cardiac failure. However, EBRT has been shown to be feasible and efficient in recent studies, 6,11 and pioneering surgeons have reported promising outcomes. 12,13 In this review, we have discussed the efficacy and feasibility of local treatments including EBRT and surgery, as well as future therapeutic strategies that can be considered alongside systemic treatments.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Local Treatments for Hepatocellular Carcinoma Involving the Inferior Vena Cava and/or Right Atrium

Lee

Rim

2020

JHC

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Major vessel invasion is frequently observed in locally advanced hepatocellular carcinoma (HCC). The most commonly involved major vessel is the portal vein; however, approximately 4% of patients with HCC have inferior vena cava (IVC) and/or right atrium (RA) invasion. Although these conditions have dismal prognoses, local treatments have not been regularly administered because they may affect systemic circulation. Owing to recent technological advances, various local treatments including surgery and external radiotherapy have increasingly been performed in these patients. Since irradiating tumorous lesions in the liver while preserving normal tissues is possible and major vessels are relatively resistant to radiation, external radiotherapy has been a feasible palliative modality for treating vessel-invasive HCC. In addition, systemic fatal complications that were initially a cause of concern have become rare after radiotherapy. While invasive procedures such as extracorporeal circulation or hepatic vascular exclusion may be required, pioneering surgeons have performed surgical resections in selected patients and have obtained promising results. Surgery has shown the best survival outcomes compared to other treatment options including radiotherapy, but the possibility of perioperative morbidity should be considered. In addition, a combination of local treatment and novel systemic agents, which demonstrated better survival and response rates than sorafenib, is expected to maximize therapeutic effects. In this review, we have discussed the most recent treatments for HCC with IVC and/or RA involvement and have provided information intended to guide therapeutic decisions and facilitate future research.

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Combined local therapy and CAR‐GPC3 T‐cell therapy in advanced hepatocellular carcinoma: a proof‐of‐concept treatment strategy

Shi

Chi

et al. 2023

Cancer Communications

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Effectiveness and feasibility of external beam radiotherapy for hepatocellular carcinoma with inferior vena cava and/or right atrium involvement: a multicenter trial in Korea (KROG 17-10)

Cited by 16 publications

References 26 publications

Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta-analysis

Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta-analysis

Efficacy of Local Treatments for Hepatocellular Carcinoma Involving the Inferior Vena Cava and/or Right Atrium

Combined local therapy and CAR‐GPC3 T‐cell therapy in advanced hepatocellular carcinoma: a proof‐of‐concept treatment strategy

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