Individualized Adaptive Radiation Therapy Allows for Safe Treatment of Hepatocellular Carcinoma in Patients With Child-Turcotte-Pugh B Liver Disease

Jackson, W. Clay; Tang, Ming; Maurino, C.; Mendiratta‐Lala, Mishal; Parikh, Neehar D.; Matuszak, Martha M.; Dow, J.; Cao, Yue; Mayo, Charles S.; Haken, R.K. Ten; Schipper, Matthew J.; Cuneo, Kyle C.; Owen, Dawn; Lawrence, Theodore S.

doi:10.1016/j.ijrobp.2020.08.046

Cited by 22 publications

(24 citation statements)

References 23 publications

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“…ICG clearance has been used to understand changes in liver function during treatment and as a guide for radiation treatment adaptation [9] . More recently, ALBI score has been shown to predict toxicity, and multiple groups are exploring ALBI for prediction of toxicity in the setting of liver irradiation [10] , [11] , [12] – 13] . ALBI was the best predictor of toxicity in our study population.…”

Section: Discussionmentioning

confidence: 99%

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TNFR1 and the TNFα axis as a targetable mediator of liver injury from stereotactic body radiation therapy

Cousins

Morris

Maurino

et al. 2021

Translational Oncology

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Highlights Elevated soluble TNFR1 levels are predictive of liver toxicity among patients receiving radiation. Soluble TNFR1 levels do not independently predict liver toxicity when included in models with ALBI and mean liver dose. Data suggest that liver inflammation mediates toxicity after liver irradiation and that the TNFα axis is associated with this inflammation. Future studies of should evaluate approaches that target pre-treatment inflammation to reduce the risk of toxicity.

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Section: Discussionmentioning

confidence: 99%

“…Cross-validated AUC is used to evaluate the performance of the logistic regression models. Because some information may be lost by collapsing change in CP into a binary outcome, a longitudinal model was also fitted as a more efficient alternative [12] . Marginal R-squared was used to compare the performance of the longitudinal models.…”

Section: Methodsmentioning

confidence: 99%

TNFR1 and the TNFα axis as a targetable mediator of liver injury from stereotactic body radiation therapy

Cousins

Morris

Maurino

et al. 2021

Translational Oncology

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“…The proposed adjustment of radiation dose based on ICGR15 was feasible and led to high local control rates (1y = 99%; 2y = 95%) with low complication rates (increase in CPS 1 or 2 points within 6 months: 14%/7%). Interestingly, a recent study by the same group found that an ALBI-centric model performed equivalently to the ICGR15 model (AUC = 0.79 for both), supporting the use of the less labor-intensive ALBI grade as a biomarker [39]. More importantly, only preand mid-treatment levels of ALBI were associated with liver toxicity following radiation.…”

Section: Indocyanine Green (Icg) Testmentioning

confidence: 90%

“…Potential Predictive Scores/Biomarkers ALBI [23][24][25][26][27]29] ALBI [23][24][25]29,39] Absolute lymphocyte count [43] Indocyanin Green Retention [35][36][37] Hepatocyte growth factor (HGF) [40,41] HGF [40,41] CD40 Ligand (CD40L) [45] sCD40L [40,45] Platelet-to-lymphocyte ratio [43] Transforming growth factor (TGF)-β [42] Neutrophile-to-Lymphocyte ratio [43,50,53] Neutrophile-to-Lymphocyte ratio [53] Interleukin 6 (IL-6) [43,44] Eotaxin [42] Interleukin 10 (IL-10) [44] TNF receptor I (TNFR-I) [46] Tumor Necrosis Factor receptor II [45] TNFR-II [45] Circulating lymphocyte counts [47,[49][50][51][52] Circulating lymphocyte counts [49] Tumor Necrosis Factor (TNF)-α [51] Micro RNAs [101] Cell-free DNA [90] Plasma metabolites [98] Ceramide [99] Programmed cell d...…”

Section: Potential Prognostic Scores/biomarkersmentioning

confidence: 99%

Leveraging Blood-Based Diagnostics to Predict Tumor Biology and Extend the Application and Personalization of Radiotherapy in Liver Cancers

Hauth

Roberts

Hong

et al. 2022

IJMS

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While the incidence of primary liver cancers has been increasing worldwide over the last few decades, the mortality has remained consistently high. Most patients present with underlying liver disease and have limited treatment options. In recent years, radiotherapy has emerged as a promising approach for some patients; however, the risk of radiation induced liver disease (RILD) remains a limiting factor for some patients. Thus, the discovery and validation of biomarkers to measure treatment response and toxicity is critical to make progress in personalizing radiotherapy for liver cancers. While tissue biomarkers are optimal, hepatocellular carcinoma (HCC) is typically diagnosed radiographically, making tumor tissue not readily available. Alternatively, blood-based diagnostics may be a more practical option as blood draws are minimally invasive, widely availability and may be performed serially during treatment. Possible blood-based diagnostics include indocyanine green test, plasma or serum levels of HGF or cytokines, circulating blood cells and genomic biomarkers. The albumin–bilirubin (ALBI) score incorporates albumin and bilirubin to subdivide patients with well-compensated underlying liver dysfunction (Child–Pugh score A) into two distinct groups. This review provides an overview of the current knowledge on circulating biomarkers and blood-based scores in patients with malignant liver disease undergoing radiotherapy and outlines potential future directions.

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“…Common adverse effects associated with SBRT include fatigue, anorexia, and liver decompensation. Patients with severe hepatic dysfunction have a relative contraindication to SBRT; however, there is some evidence that adaptive protocols that tailor radiation dosing to changes in liver dysfunction during treatment can help avoid significant decompensation in high‐risk patients 18,19 …”

Section: Stereotactic Body Radiation Therapymentioning

confidence: 99%

Radiation Therapies for the Treatment of Hepatocellular Carcinoma

Parikh

Cuneo

Mendiratta‐Lala

2021

Clinical Liver Disease

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Hepatocellular carcinoma (HCC) is a leading cause of worldwide cancer mortality. 1 There is emerging favorable evidence behind the efficacy of radiation therapy in the form of transarterial radioembolization (TARE) and external beam radiation therapy for patients with HCC. Herein, we review the evidence for the use of these therapies, the assessment of treatment response, and the future directions needed for wider application of radiation therapy for the treatment of HCC. TareTARE with yttrium-90-embedded glass or resin microspheres was given compassionate use approval by the US Food and Drug Administration in 1999, and with refinement in technique and patient selection, it has become an increasingly used form of locoregional therapy for HCC. 2,3 The principle behind TARE infusion is intra-arterial delivery of high-dose ionizing radiation into the tumor bed via the hepatic artery, with continuous radiation exposure as the yttrium-90 decays. TARE is typically conducted in a two-step process, with a 99m technecium-labeled macroaggregated albumin mapping study prior to treatment to evaluate possible deposition of microspheres in extrahepatic sites, although patients with early-stage HCC (T1 or T2) may be able to avoid the mapping procedure. 4 The efficacy of TARE has been evaluated across multiple stages of HCC (Table 1). In early-stage HCC, "radiation

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Individualized Adaptive Radiation Therapy Allows for Safe Treatment of Hepatocellular Carcinoma in Patients With Child-Turcotte-Pugh B Liver Disease

Cited by 22 publications

References 23 publications

TNFR1 and the TNFα axis as a targetable mediator of liver injury from stereotactic body radiation therapy

TNFR1 and the TNFα axis as a targetable mediator of liver injury from stereotactic body radiation therapy

Leveraging Blood-Based Diagnostics to Predict Tumor Biology and Extend the Application and Personalization of Radiotherapy in Liver Cancers

Radiation Therapies for the Treatment of Hepatocellular Carcinoma

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