Non-classic radiation-induced liver disease after intensity-modulated radiotherapy for Child–Pugh grade B patients with locally advanced hepatocellular carcinoma

Li, Jianxu; Zhang, Ruijun; Qiu, Moqin; Yan, Liu-Ying; He, Meiling; Long, Mei-Ying; Zhong, Jian‐Hong; Lu, Huajun; Zhou, Hongmei; Xiang, Bang‐De; Liang, Shi-Xiong

doi:10.1186/s13014-023-02232-5

Cited by 4 publications

(2 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Age, tumor number, and PT were found to be optimal predictors for ncRILD to construct an effective model. Moreover, the tumor number and PT were the most significant factors associated with ncRILD for patients with Child–Pugh grade B with HCC after IMRT [ 34 ]. According to the model, the probability of ncRILD was relatively low for patients with lower scores, which predicts the safety of RT.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy plus anti-PD1 versus radiotherapy for hepatic toxicity in patients with hepatocellular carcinoma

Zhang

Zhou

et al. 2023

Radiat Oncol

Self Cite

View full text Add to dashboard Cite

Purpose In this study, we aimed to compare the radiation-induced hepatic toxicity (RIHT) outcomes of radiotherapy (RT) plus antibodies against programmed cell death protein 1 (anti-PD1) versus RT alone in patients with hepatocellular carcinoma (HCC), evaluate prognostic factors of non-classic radiation-induced liver disease (ncRILD), and establish a nomogram for predicting the probability of ncRILD. Patients and methods Patients with unresectable HCC treated with RT and anti-PD1 (RT + PD1, n = 30) or RT alone (n = 66) were enrolled retrospectively. Patients (n = 30) in each group were placed in a matched cohort using propensity score matching (PSM). Treatment-related hepatotoxicity was evaluated and analyzed before and after PSM. The prognostic factors affecting ncRILD were identified by univariable logistic analysis and Spearman’s rank test in the matched cohort to generate a nomogram. Results There were no differences in RIHT except for increased aspartate aminotransferase (AST) ≥ grade 1 and increased total bilirubin ≥ grade 1 between the two groups before PSM. After PSM, AST ≥ grade 1 occurred more frequently in the RT + PD1 group (p = 0.020), and there were no significant differences in other hepatotoxicity metrics between the two groups. In the matched cohort, V25, tumor number, age, and prothrombin time (PT) were the optimal prognostic factors for ncRILD modeling. A nomogram revealed a good predictive performance (area under the curve = 0.82). Conclusions The incidence of RIHT in patients with HCC treated with RT + PD1 was acceptable and similar to that of RT treatment. The nomogram based on V25, tumor number, age, and PT robustly predicted the probability of ncRILD.

show abstract

Section: Discussionmentioning

confidence: 99%

Radiotherapy plus anti-PD1 versus radiotherapy for hepatic toxicity in patients with hepatocellular carcinoma

Zhang

Zhou

et al. 2023

Radiat Oncol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Radiotherapy has gradually become one of the main treatment methods for unresectable HCC. 71 , 72 However, the efficacy of adjuvant radiotherapy for HCC after curative hepatectomy remains controversial. A randomized trial (n=119) found that adjuvant radiotherapy was technically feasible and relatively safe for centrally located HCCs after narrow-margin hepatectomy but did not improve RFS and OS.…”

Section: Unanswered Questions Of Adjuvant Treatmentmentioning

confidence: 99%

Adjuvant Therapy for Hepatocellular Carcinoma After Curative Treatment: Several Unanswered Questions

Li,

Pan

et al. 2024

J Clin Transl Hepatol

View full text Add to dashboard Cite

Most patients with hepatocellular carcinoma (HCC) have a poor prognosis. Hepatectomy and local ablation are the main curative treatments for HCC. Nevertheless, the recurrence rate after hepatectomy or ablation is up to 70%, which seriously affects patient prognosis. Several adjuvant therapies have been explored to reduce postoperative recurrence. However, although a variety of adjuvant therapies have been shown to reduce the recurrence rate and improve overall survival, a standard consensus of national HCC guidelines for adjuvant treatment is lacking. Therefore, there are significant differences in the recommendations for adjuvant therapy for HCC between the Eastern and Western guidelines. A variety of adjuvant treatment methods, such as antiviral therapy, transarterial chemoembolization or traditional Chinese medicine, are recommended by the Chinese HCC guidelines. However, Western guidelines make few recommendations other than antiviral therapy. Adjuvant immune checkpoint inhibitors are recommended only in the recently updated American Association for the Study of Liver Diseases guidelines. This review summarized the existing adjuvant therapy options after curative hepatectomy or ablation and discusses several important dilemmas of adjuvant treatments.

show abstract

Managing hepatocellular carcinoma across the stages: efficacy and outcomes of stereotactic body radiotherapy

Mohamed,

Berres,

Bruners

et al. 2024

Strahlenther Onkol

View full text Add to dashboard Cite

Purpose Hepatocellular carcinoma (HCC) poses a unique challenge due to its predilection for developing on compromised livers, often limiting surgical options. Stereotactic body radiotherapy (SBRT) has emerged as a promising local treatment modality for HCC. This study aims to assess the effectiveness of SBRT in HCC patients not suitable for surgery, focusing on local control, optimal radiation dosing, and prognostic factors. Methods In this retrospective analysis, 52 HCC patients treated with SBRT were examined. The study assessed local control, progression-free survival (PFS), and overall survival (OS) while conducting dosimetric analyses. The relationship between mean liver dose and Child–Pugh score (CPS) progression was also explored. Results SBRT demonstrated 93.4% freedom from local progression (FFLP) at 12 months. Notably, a near minimum dose (D98%) below 61 Gy as an equivalent dose in 2‑Gy fractions with α/β 10 Gy (EQD2α/β10) was associated with reduced FFLP (p-value 0.034). Logistic regression analysis revealed a dose–response relationship for FFLP and D98% with 95% and 98% probability of FFLP at a dose of 56.9 and 73.1 Gy, respectively. The study observed OS rates of 63.7% at 1 year and 34.3% at 3 years. Patients with portal vein tumor thrombus (PVTT) and larger tumors (≥ 37 cm3) experienced decreased PFS and OS. Multivariate analysis identified PVTT, larger tumor volume, and performance status as independent predictors of reduced OS. Notably, classical radiation-induced disease (cRILD) was absent, but nonclassical (nc) RILD occurred in 7.7% of patients. Regression analysis linked a mean EQD2α/β3–8 dose to the liver (12.8–12.6) with a 10% likelihood of ncRILD. Conclusion SBRT offers a compelling option for achieving high local control and promising survival outcomes in HCC. The study supports a radiation dose range of 61–73.1 Gy, coupled with a mean liver dose under 12.6–12.8 Gy as EQD2, to achieve favorable FFLP rates, with acceptable toxicity rates.

show abstract

Non-classic radiation-induced liver disease after intensity-modulated radiotherapy for Child–Pugh grade B patients with locally advanced hepatocellular carcinoma

Cited by 4 publications

References 33 publications

Radiotherapy plus anti-PD1 versus radiotherapy for hepatic toxicity in patients with hepatocellular carcinoma

Radiotherapy plus anti-PD1 versus radiotherapy for hepatic toxicity in patients with hepatocellular carcinoma

Adjuvant Therapy for Hepatocellular Carcinoma After Curative Treatment: Several Unanswered Questions

Managing hepatocellular carcinoma across the stages: efficacy and outcomes of stereotactic body radiotherapy

Contact Info

Product

Resources

About