Stereotactic body radiation therapy for centrally located hepatocellular carcinoma: outcomes and toxicities

Lazarev, Stanislav; Hardy-Abeloos, Camille; Factor, O.; Rosenzweig, Kenneth E.; Buckstein, Michael

doi:10.1007/s00432-018-2729-y

Cited by 18 publications

(7 citation statements)

References 17 publications

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“…These findings are consistent with those of the CheckMate 040 trial which demonstrated a 25% rate of grade 3/4 adverse events (no grade 5 events reported) in the dose-escalation arm, primarily due to elevation in laboratory values [10]. Likewise, these data are consistent with previous reports of toxicity among patients undergoing definitive SBRT alone for HCC [13,22].…”

Section: Discussionsupporting

confidence: 90%

Safety of nivolumab in combination with prior or concurrent radiation therapy in hepatocellular carcinoma

Smith

McGee

et al. 2020

J Radiat Oncol

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Objectives Nivolumab has been demonstrated to be effective for the treatment of unresectable hepatocellular carcinoma (HCC). While many patients may additionally benefit from radiation therapy (RT), the toxicity of combination nivolumab and RT is unknown. Methods Patients who underwent liver-directed RT prior to or concurrent with nivolumab for HCC at our institution were reviewed. Toxicity was assessed by Common Terminology Criteria for Adverse Effects v5.0 criteria until disease progression, change in systemic therapy, additional liver-targeted locoregional therapy (LRT), or death. Prevalence ratios (PR) were compared for patients undergoing prior and concurrent RT. Childs-Turcotte-Pugh (CTP) and Albumin-Bilirubin (ALBI) scores at 1-, 3-, and 6-months were compared with baseline. ResultsWe identified 55 patients with median follow-up 6.0 months; 34 (62%) received prior and 21 (38%) received concurrent RT. Grade 3+ toxicity occurred in 8 patients (17%). Grade 3+ toxicities did not differ between prior and concurrent RT cohorts on the univariable analysis (

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Section: Discussionsupporting

confidence: 90%

Safety of nivolumab in combination with prior or concurrent radiation therapy in hepatocellular carcinoma

Smith

McGee

et al. 2020

J Radiat Oncol

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“…52 Stereotactic ablative body radiotherapy may have an advantage as a non-invasive ablative option for peripheral and subphrenic HCCs as well as the more central tumors abutting biliary structures or major blood vessels. 30,53 Central or left-sided HCCs bordering the duodenum or stomach can present challenges to dose escalation; however, treatment delivery is still feasible with appropriate motion management techniques and dose reductions at the interface. Risk estimates for bowel injury following SABR have been developed with the low-risk limits (< 5% risk of grade ≥ 3 toxicity) generally achievable with the dose ranges used for treating HCC.…”

Section: Patient Selectionmentioning

confidence: 99%

Stereotactic radiotherapy for hepatocellular carcinoma: Expanding the multidisciplinary armamentarium

Shanker

Liu

Lee

et al. 2020

J of Gastro and Hepatol

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Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the third most common cause of cancer-related death. Long-term prognosis remains poor with treatment options frequently limited by advanced tumor stage, tumor location, or underlying liver dysfunction. Stereotactic ablative body radiotherapy (SABR) utilizes technological advances to deliver highly precise, tumoricidal doses of radiation. There is an emerging body of literature on SABR in HCC demonstrating high rates of local control in the order of 80-90% at 3 years. SABR is associated with a low risk of radiation-induced liver disease or decompensation in appropriately selected HCC patients with compensated liver function and is now being incorporated into guidelines as an additional treatment option. This review outlines the emerging role of SABR in the multidisciplinary management of HCC and summarizes the current evidence for its use as an alternative ablative option for early-stage disease, as a bridge to transplant, and as palliation for advanced-stage disease. We outline specific considerations regarding patient selection, toxicities, and response assessment. Finally, we compare current international guidelines and recommendations for the use of SABR and summarize ongoing studies. Indications for stereotactic ablative body radiotherapy in hepatocellular carcinomaStereotactic ablative body radiotherapy has potential application across a broad range of indications from ablation of early-stage disease through to palliation of advanced-stage disease (Fig. 1). Key studies are summarized (Table 1). Figure 1 Potential indications for stereotactic radiotherapy in hepatocellular carcinoma according to Barcelona Clinic Liver Cancer stage. HCC, hepatocellular carcinoma; MVI, macrovascular invasion; OLT, orthotopic liver transplantation; RT, radiation therapy; SABR, stereotactic ablative body radiotherapy; TACE, transarterial chemoembolization; TARE, transarterial radioembolization. [Color figure can be viewed at wileyonlinelibrary.com] Stereotactic radiotherapy for HCC MD Shanker et al.

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“… 73 It is unclear whether there exists a clear dose response for local control, with differing opinions in the literature. 72 , 86 , 104 Single fraction SBRT (26-40 Gy) led to good local control in phase I/II trials for liver metastases, while reports on its application in HCC are limited. [105] , [106] , [107] The critical luminal structures and healthy non-tumorous liver often limit the dose delivered.…”

Section: Future Directionsmentioning

confidence: 99%

Stereotactic body radiation therapy for hepatocellular carcinoma: From infancy to ongoing maturity

et al. 2022

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Stereotactic body radiation therapy for centrally located hepatocellular carcinoma: outcomes and toxicities

Abstract: In the present cohort, SBRT to the CL-HCC produced excellent treatment response with acceptable HBT and LC. Select HCC patients who are not candidates for surgery or other locoregional therapies can be considered for SBRT to the central liver.

Cited by 18 publications

References 17 publications

Safety of nivolumab in combination with prior or concurrent radiation therapy in hepatocellular carcinoma

Safety of nivolumab in combination with prior or concurrent radiation therapy in hepatocellular carcinoma

Stereotactic radiotherapy for hepatocellular carcinoma: Expanding the multidisciplinary armamentarium

Stereotactic body radiation therapy for hepatocellular carcinoma: From infancy to ongoing maturity

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