Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

Xu, Melody J.; Feng, Mary

doi:10.1055/s-0038-1676098

Cited by 11 publications

(7 citation statements)

References 99 publications

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“…However, most international guidelines still do not recommend ERT to treat HCC with few exceptions due to the severe hepatotoxicity of the normal tissues after absorbing radiation more than 35 Gy. Since the early 1990s, radiotherapy (RT) has experienced tremendous technological advancements to develop IRT, which can precisely deliver very high tumoricidal dose to the tumor while preserving normal liver parenchyma ( 50 ). According to the pharmacokinetics of radionuclides, IRT can be properly indicated in HCC accompanied by PVTT with the OS reaching more than 20 months ( 51 ).…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Adjuvant Treatment for Resected Hepatocellular Carcinoma: A Systematic Review and Network Meta-Analysis

Liu¹,

Wang²,

Guo³

et al. 2021

Front. Oncol.

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BackgroundIt is controversial whether adjuvant treatment could be recommended for hepatocellular carcinoma (HCC) after curative hepatectomy. Thus, we performed a network meta-analysis (NMA) to assess adjuvant treatment’s benefit and determine the optimal adjuvant regimen.MethodsWe systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials comparing adjuvant therapy versus no active treatment after curative hepatectomy among patients with HCC. Pooled data on recurrence and overall survival (OS) were analyzed within pairwise meta-analysis and NMA.ResultsTwenty-three eligible trials (3,940 patients) reporting eight treatments were included. The direct meta-analysis showed that adjuvant therapy prevented the recurrence (OR = 0.65; 95% CI: 0.55, 0.77; P = 0.177; I2 = 21.7%) and contributed to OS (HR = 0.63; 95% CI: 0.54, 0.73; P = 0.087; I2 = 31.1%) in comparison to the observation. In the NMA, internal radiotherapy (IRT; OR = 0.55; 95% CI: 0.39, 0.77; SUCRA = 87.7%) followed by hepatic artery infusion chemotherapy (HAIC; OR = 0.6; 95% CI: 0.36, 0.97; SUCRA = 77.8%), and HAIC (HR = 0.44; 95% CI: 0.21, 0.87; SUCRA = 82.6%) followed by IRT (HR 0.54; 95% CI:0.36, 0.81; SUCRA = 69.7%) were ranked superior to other treatments in terms of preventing recurrence and providing survival benefit, respectively.ConclusionsThe addition of adjuvant therapy lowers the risk of recurrence and provide survival benefit after surgical resection for HCC. HAIC and IRT are likely to be the two most effective adjuvant regimens.Systematic Review Registrationhttps://inplasy.com/inplasy-2020-11-0039/.

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Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Adjuvant Treatment for Resected Hepatocellular Carcinoma: A Systematic Review and Network Meta-Analysis

Liu¹,

Wang²,

Guo³

et al. 2021

Front. Oncol.

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“…Also, local radiation to the liver was applied. There are no large random-ized studies regarding radiotherapy for the treatment of HCC [12]. For this reason, radiation is not highly ranked in current clinical practice guidelines [13].…”

Section: Discussionmentioning

confidence: 99%

Response of advanced HCC to pembrolizumab and lenvatinib combination therapy despite monotherapy failure

Schulte

Zhan

et al. 2020

Z Gastroenterol

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In recent years, immune checkpoint inhibitors (ICIs) were successfully introduced to cancer therapy, and these drugs have already become essential for the treatment of various noncurable tumors. However, monotherapy in advanced hepatocellular carcinoma (aHCC) failed to show statistically significant improvement.Recently, the combination of atezolizumab and bevacizumab demonstrated efficacy of combining ICI and VEGF inhibition, further substantiating previous data on synergistic mechanisms among respective substance classes.As TKI treatment is currently standard of care for aHCC, and ICIs are approved by the FDA and available in many areas of the world, numerous patients may have been treated with monotherapy of those drugs. However, it remains unclear if failure to monotherapy has an impact on combination therapy. We therefore report a patient well responding to combination therapy despite previous failures to TKI and ICI monotherapy.

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“…SBRT delivers focused radiation under image guidance sparing large portions of the liver while providing ablative potential within the tumor, achieving local HCC control rates around 90% and similar survival compared to TACE and radiofrequency ablation. [ 50 , 61 , 62 ] Similar to that seen in the resection and LT literature, factors influencing post-LRT recurrence and overall survival include tumor number and size, AFP, liver dysfunction (e.g. bilirubin, albumin, Child–Pugh score), and vascular invasion.…”

Section: Models To Predict Hcc Recurrencementioning

confidence: 96%

Models to Predict Development or Recurence of Hepatocellular Carcinoma (HCC) in Patients with Advanced Hepatic Fibrosis

Yilma

Saxena

Mehta

2022

Curr Gastroenterol Rep

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Purpose of Review Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death in the United States (U.S.).1 The purpose of this review is to highlight published models that predict development of HCC and estimate risk of HCC recurrence after treatments. Recent Findings There have been several models created for both de novo HCC and HCC recurrence, with the more recent models using a combination of age, sex, decompensation, and laboratory values (platelet count, albumin, bilirubin), and liver disease etiology to predict both 5 and 10-year HCC incidence. For chronic hepatitis C, sustained virologic response has been a useful component of understanding HCC risk reduction. BMI and diabetes have been utilized in non-alcoholic fatty liver disease (NAFLD) models to predict HCC risk. For HCC recurrence after treatment (for both surgical resection and liver transplant), tumor size and number, vascular invasion, alpha-fetoprotein (AFP) and neutrophil to lymphocyte ratio (NLR) are all components of HCC recurrence risk models. Summary Although numerous HCC risk prediction models have been established over the last several years, challenges remain including how to best incorporate these models into clinical practice, improve surveillance for NAFLD-HCC development, and determine timing and duration of post-resection recurrence surveillance.

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Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

Cited by 11 publications

References 99 publications

Comparative Effectiveness of Adjuvant Treatment for Resected Hepatocellular Carcinoma: A Systematic Review and Network Meta-Analysis

Comparative Effectiveness of Adjuvant Treatment for Resected Hepatocellular Carcinoma: A Systematic Review and Network Meta-Analysis

Response of advanced HCC to pembrolizumab and lenvatinib combination therapy despite monotherapy failure

Models to Predict Development or Recurence of Hepatocellular Carcinoma (HCC) in Patients with Advanced Hepatic Fibrosis

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