Hypofractionated radiotherapy for hepatocellular carcinomas adjacent to the gastrointestinal tract

Abstract

Aim: Decisions regarding therapeutic plans for inoperable patients with hepatocellular carcinoma (HCC) adjacent to the gastrointestinal (GI) tract are challenging because radiofrequency ablation has the potential risk of thermal injury. Moreover, the response rate of transcatheter arterial chemoembolization is relatively low and stereotactic body radiotherapy (SBRT) is believed to be too toxic. We have applied hypofractionated radiotherapy (HFRT) for such lesions. This study investigated the outcomes and toxicities of this treatment. Methods: Among consecutive HCC patients treated with radiotherapy with curative intent at our institution between 2015 and 2019, we retrospectively extracted those outside of the indication for SBRT due to exceeding the constraint of the GI tract and who were treated using HFRT with a prescription dose of 42 Gy in 14 fractions and prophylactic proton pump inhibitor administration for 6 months. The oncological outcomes and toxicities were investigated. Results: A total of 66 patients with 73 lesions were eligible. The median follow-up period was 24.0 months. The local recurrence, intrahepatic recurrence, liver-related death, and overall survival rates at 2 years were 11.3%, 50.6%, 15.9%, and 60.4%, respectively. Six (9.1%) patients experienced Child-Pugh score deterioration ≥2 within 6 months following treatment. Two and one patient developed grades 2 and 3 gastroduodenal bleeding, respectively. Conclusions: HFRT can achieve good local control in patients with HCC adjacent to the GI tract, with low GI toxicity incidence. Our study demonstrated that HFRT can be a potentially curative treatment option for lesions.

Stereotactic Radiotherapy for Critically Located Pancreatic and Biliary Targets: A Review on Simultaneous Integrated Protection and Other Dose-Painting Strategies to Minimize Dose to Critical Organs at Risk

“…SIP is, therefore, a deliberated way to deliver the maximum allowed dose to the overlap area (the so-called SIP volume), while maintaining higher dose in the area "far" from critical structures [7]. SIP concept could be used both for moderately hypofractionated RT and SRT [8][9][10].…”

Hypofractionated radiotherapy for hepatocellular carcinoma adjacent to the gastrointestinal tract

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The study by Tsurugai et al in this issue of Hepatology Research reports the outcomes and toxicities of hypofractionated radiotherapy for inoperable hepatocellular carcinoma (HCC) adjacent to the gastrointestinal (GI) tract. 1 The authors suggest that hypofractionated radiotherapy may be an alternative to stereotactic body radiation therapy (SBRT) for these patients. In general, GI toxicities, such as ulcer, bleeding, and perforation, are important dose-limiting factors for SBRT, [2][3][4] and HCC adjacent to the GI tract may contraindicate SBRT.

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