Modeling of Normal Tissue Complications Using Imaging and Biomarkers After Radiation Therapy for Hepatocellular Carcinoma

Naqa, Issam El; Johansson, Amanda; Owen, Dawn; Cuneo, Kyle C.; Cao, Yue; Matuszak, Martha M.; Bazzi, Latifa; Lawrence, Theodore S.; Haken, R.K. Ten

doi:10.1016/j.ijrobp.2017.10.005

Cited by 46 publications

(31 citation statements)

References 50 publications

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“…64 The use of blood and imaging biomarkers in the selection of treatments for HCC is needed, beyond the use of Indocyanine green (ICG) dye clearance to assess liver function and guide dose schedules. 65 More integration of radiological biomarkers, even the use of functional imaging to select patients who will benefit from SBRT needs further study.…”

Section: Future Directionsmentioning

confidence: 99%

Current Understanding of Ablative Radiation Therapy in Hepatocellular Carcinoma

Mathew¹,

Dawson²

2021

JHC

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The role of ablative stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma (HCC) has been evolving over the last few decades. SBRT has mostly been used in early stages of HCC, including few (≤ 3 in number) tumors, small tumours (< 3 cm in size), as well as larger tumours which are ineligible for other ablative modalities, mostly without vascular invasion. In early stage HCC, SBRT is used as a definitive treatment with curative intent or with intent to bridge to liver transplant. Retrospective and prospective institutional series document a high rate of local control (68–95% at 3 years) following SBRT. This coupled with a low risk of toxicity makes this non-invasive ablative treatment an attractive option for patients who are ineligible for other ablative treatments. Small randomized studies of ablative radiation have also shown non-inferiority of radiation as compared to radiofrequency ablation (RFA). Currently, SBRT is widely available as a safe and effective liver directed therapy, although there is a need for more studies providing higher level evidence. This review gives a brief overview of SBRT and the evidence for its use in HCC patients with ablative intent.

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Section: Future Directionsmentioning

confidence: 99%

Current Understanding of Ablative Radiation Therapy in Hepatocellular Carcinoma

Mathew¹,

Dawson²

2021

JHC

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“…The primary consideration is sparing of non-tumor involved liver tissue [31,32]. Integration of patient-specific functional imaging may further aid in the treatment planning process to limit radiation-induced toxicities [33][34][35][36][37]. Selection of dose-fractionation scheme for a given patient remains an active area of investigation.…”

Section: Advancements In Radiotherapy and A Newly Established Role In Hcc Treatmentmentioning

confidence: 99%

Stereotactic Ablative Radiotherapy (SABR/SBRT) for Hepatocellular Carcinoma

Rhieu

Narang

Meyer

2018

Curr Hepatology Rep

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Purpose of Review Liver-directed SABR (stereotactic ablative body radiotherapy) is emerging as an effective local therapy option for HCC (hepatocellular carcinoma). This review summarizes recent clinical progresses and proposes future directions. Recent Findings SABR is an effective and safe, non-invasive local therapy option for HCC in the primary and salvage treatment settings, as well as a bridge to liver transplantation in selected patients. Randomized trials comparing SABR with other locoregional modalities are currently ongoing. Summary Research efforts are being made toward better predicting normal tissue toxicity and tumor radiosensitivity for a tailored maximal safe treatment in HCC SABR. More recently, potential synergy with immunotherapies is of increasing interest in HCC.

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“…Until then, the model needs careful validation and restriction prior to clinical application even for the model-based approach. In addition, the novel predictive markers as well as radiogenomic data have been of greater interest for RILD [ 34 , 35 ]. These potential biomarkers are capable of being integrated at any time into the multivariable NTCP model for improving prediction ability and reliability.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the confidence interval in the multivariable normal tissue complication probability model for predicting radiation-induced liver disease in primary liver cancer

Prayongrat

Srimaneekarn

Sriswasdi

et al. 2021

Journal of Radiation Research

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We developed a confidence interval-(CI) assessing model in multivariable normal tissue complication probability (NTCP) modeling for predicting radiation-induced liver disease (RILD) in primary liver cancer patients using clinical and dosimetric data. Both the mean NTCP and difference in the mean NTCP (ΔNTCP) between two treatment plans of different radiotherapy modalities were further evaluated and their CIs were assessed. Clinical data were retrospectively reviewed in 322 patients with hepatocellular carcinoma (n = 215) and intrahepatic cholangiocarcinoma (n = 107) treated with photon therapy. Dose–volume histograms of normal liver were reduced to mean liver dose (MLD) based on the fraction size-adjusted equivalent uniform dose. The most predictive variables were used to build the model based on multivariable logistic regression analysis with bootstrapping. Internal validation was performed using the cross-validation leave-one-out method. Both the mean NTCP and the mean ΔNTCP with 95% CIs were calculated from computationally generated multivariate random sets of NTCP model parameters using variance–covariance matrix information. RILD occurred in 108/322 patients (33.5%). The NTCP model with three clinical and one dosimetric parameter (tumor type, Child–Pugh class, hepatitis infection status and MLD) was most predictive, with an area under the receiver operative characteristics curve (AUC) of 0.79 (95% CI 0.74–0.84). In eight clinical subgroups based on the three clinical parameters, both the mean NTCP and the mean ΔNTCP with 95% CIs were able to be estimated computationally. The multivariable NTCP model with the assessment of 95% CIs has potential to improve the reliability of the NTCP model-based approach to select the appropriate radiotherapy modality for each patient.

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Modeling of Normal Tissue Complications Using Imaging and Biomarkers After Radiation Therapy for Hepatocellular Carcinoma

Cited by 46 publications

References 50 publications

Current Understanding of Ablative Radiation Therapy in Hepatocellular Carcinoma

Current Understanding of Ablative Radiation Therapy in Hepatocellular Carcinoma

Stereotactic Ablative Radiotherapy (SABR/SBRT) for Hepatocellular Carcinoma

Assessment of the confidence interval in the multivariable normal tissue complication probability model for predicting radiation-induced liver disease in primary liver cancer

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