Stereotactic body radiotherapy for primary hepatic malignancies – Report of a phase I/II institutional study

Weiner, Ashley A.; Olsen, Jeffrey R.; Ma, Daniel; Dyk, Pawel; DeWees, T.A.; Myerson, Robert J.; Parikh, Parag J.

doi:10.1016/j.radonc.2016.07.020

Cited by 81 publications

(90 citation statements)

References 25 publications

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“…Additional, smaller, prospective studies reported by Weiner et al 46 and Kim et al 48 demonstrated similar results (see Table 1). Collectively, these prospective studies (encompassing results from more than 350 patients with HCC) demonstrate that, for a well selected group of patients, HIGRT with photon-based therapy is an appropriate treatment option.…”

Section: Prospective Modern Trialssupporting

confidence: 70%

“…Several prospective, nonrandomized studies have evaluated the use of HIGRT for treatment of HCC (Table 1). [43][44][45][46][47][48][49][50][51][52] These experiences suggest that HIGRT is well tolerated, with acceptable toxicities and excellent local control (LC) rates. However, follow-up is relatively short, and many trials have not reached a median survival endpoint.…”

Section: Prospective Modern Trialsmentioning

confidence: 99%

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The role of external beam radiotherapy in the treatment of hepatocellular cancer

Chino

Stephens

Marin

et al. 2018

Cancer

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Hepatocellular carcinoma (HCC) is increasing in incidence and mortality. Although the prognosis remains poor, long-term survival has improved from 3% in 1970 to an 18% 5-year survival rate today. This is likely because of the introduction of well tolerated, oral antiviral therapies for hepatitis C. Curative options for patients with HCC are often limited by underlying liver dysfunction/cirrhosis and medical comorbidities. Less than one-third of patients are candidates for surgery, which is the current gold standard for cure. Nonsurgical treatments include embolotherapies, percutaneous ablation, and ablative radiation. Technological advances in radiation delivery in the past several decades now allow for safe and effective ablative doses to the liver. Conformal techniques allow for both dose escalation to target volumes and normal tissue sparing. Multiple retrospective and prospective studies have demonstrated that hypofractionated image-guided radiation therapy, used as monotherapy or in combination with other liver-directed therapies, can provide excellent local control that is cost effective. Therefore, as the HCC treatment paradigm continues to evolve, ablative radiation treatment has moved from a palliative treatment to both a "bridge to transplant" and a definitive treatment.

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Section: Prospective Modern Trialssupporting

confidence: 70%

Section: Prospective Modern Trialsmentioning

confidence: 99%

The role of external beam radiotherapy in the treatment of hepatocellular cancer

Chino

Stephens

Marin

et al. 2018

Cancer

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“…20 Recent studies have further characterized the dose volumetric parameters associated with increased toxicity. [29][30][31][32] We were not able to establish a dosimetric parameter to predict for toxicity, possibly due to the fact that grade 3 or higher events were very rare and the aforementioned study also included grade 2 or higher events. The only dosimetric finding in our study was that higher radiation doses were associated with a rise in CTP/ ALBI.…”

Section: Discussionmentioning

confidence: 98%

Safety and Efficacy of Liver Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma After Segmental Transarterial Radioembolization

Hardy-Abeloos

Lazarev

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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Purpose: With increasing use of radiation for hepatocellular carcinoma (HCC) through transarterial radioembolization (TARE) and stereotactic body radiation therapy (SBRT), there is concern for increased radiation-related complications when using SBRT after TARE. This study compares safety of SBRT after segmental TARE versus transarterial chemoembolization (TACE). Methods and Materials: A retrospective review identified patients receiving SBRT after TACE or TARE for HCC from 2011 to 2017. TARE was delivered subselectively to individual segments using yttrium-90 with Theraspheres. Patients were assessed over time for Child-Turcott-Pugh (CTP)/albumin-bilirubin (ALBI) scores, and Common Terminology Criteria for Adverse Events version 4.0 grade !3 events. Linear mixed models were used to examine the trend of CTP and ALBI over time and compare groups. Secondary endpoints were objective response rate via modified Response Evaluation Criteria in Solid Tumors (RECIST), local control, and overall survival. Results: Ninety-nine patients met criteria with median follow-up of 9.8 months (range, 0.9-47): 31 had SBRT after segmental TARE and 68 patients post-TACE. The groups were well balanced with regard to etiology of HCC, baseline CTP and ALBI scores, and SBRT dose, but there were significant differences in baseline Eastern Cooperative Oncology Group performance status, Barcelona Clinic Liver Cancer staging, and median follow-up. There was a significant increase in post-SBRT CTP and ALBI scores (P < .0001) for both groups. However, there was no significant difference in rise in CTP (P Z .11) or ALBI score (P Z .82) over time between SBRT post-TACE versus postesegmental TARE. There was no significant increase in !grade 3 toxicity postsegmental TARE. There was also no significant difference in local controls (P Z 1.0) and overall survival (P Z .26) between cohorts, but objective response rate was worse post-TARE. Conclusions: SBRT after segmental TARE with Theraspheres appears to have acceptable tolerability and is effective compared with SBRT after TACE. Longer follow-up with larger numbers is needed to verify these data.

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“…SBRT for hepatic malignancies has been evaluated in a phase I/II study including 26 patients which reported a median survival of 11.1 months, and 1-year OS rate of 45%, with adverse events including a decline in Child-Pugh score in 9 patients and 2 grade 5 hepatic failures [61]. A small study has also evaluated SBRT as a bridge to transplantation, concluding it is a feasible and well-tolerated bridging therapy which may prolong a patient's candidacy for a curative liver transplant [62].…”

Section: Role Of External Radiotherapymentioning

confidence: 99%

Hong Kong Consensus Statements for the Management of Unresectable Hepatocellular Carcinoma

et al. 2018

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Background: Hepatocellular carcinoma (HCC) is highly prevalent in Hong Kong due to the high prevalence of chronic hepatitis B infection. Liver cancer is the fourth most common cancer and the third most common cause of cancer death. Due to the high case load, there is a high level of local expertise in treating HCC, and the full spectrum of treatment modalities is available. This document summarizes how these modalities should be used based on the latest evidence. Summary: In 2 meetings held in early 2017, a multidisciplinary group of Hong Kong clinicians, including liver surgeons, interventional radiologists, clinical oncologists, and medical oncologists, met to update local consensus statements for management of HCC. These statements are based on the latest evidence and give detailed guidance on how to deploy these modalities, in particular for cases of HCC which are not suited to surgical resection. Key Messages: These statements give detailed information on how to decide if a patient is a candidate for resection, methods to improve candidacy for resection, and guidance for use of various nonsurgical interventions to manage patients ineligible for resection.

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Stereotactic body radiotherapy for primary hepatic malignancies – Report of a phase I/II institutional study

Abstract: Background and Purpose-To report outcomes and toxicities of a single-institution Phase I/II study of stereotactic body radiotherapy (SBRT) in the treatment of unresectable hepatocellular cancer (HCC) and intrahepatic cholangiocarcinoma (IHC).

Cited by 81 publications

References 25 publications

The role of external beam radiotherapy in the treatment of hepatocellular cancer

The role of external beam radiotherapy in the treatment of hepatocellular cancer

Safety and Efficacy of Liver Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma After Segmental Transarterial Radioembolization

Hong Kong Consensus Statements for the Management of Unresectable Hepatocellular Carcinoma

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