Stereotactic body radiotherapy (SBRT) with or without surgery for primary and metastatic liver tumors

Kirichenko, Alexander; Gayou, Olivier; Parda, David S.; Kudithipudi, V.; Tom, Kusum; Khan, Rafeeq Alam; Abrams, Peter; Szramowski, Molly; Oliva, Jose; Monga, Dulabh; Raj, Moses S.; Thai, Ngoc

doi:10.1016/j.hpb.2015.07.007

Cited by 32 publications

(29 citation statements)

References 37 publications

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“…Twenty-two of the 38 patients utilized 4DCT co-registered with 99mTc-sulfur colloid Single Photon Emission Computed Tomography (SPECT) for visualization and conformal avoidance of best perfused hepatic parenchyma. Details of SPECT/CT co-registration and treatment planning have been previously reported for liver SBRT in cirrhotic HCC patients[ 19 , 20 ]. Dose limits were set such that at least 35% of predicted liver volume by SPECT imaging received ≤ 18 Gy in 5 fractions or ≤ 16 Gy in 4 fractions.…”

Section: Methodsmentioning

confidence: 99%

Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy

Hasan

Thai

Uemura

et al. 2017

WJGS

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AIMTo evaluate the control, survival, and hepatic function for Child Pugh (CP)-A patients after Stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma (HCC).METHODSFrom 2009 to 2016, 40 patients with Barcelona Liver Clinic (BCLC) stages 0-B HCC and CP-A cirrhosis completed liver SBRT. The mean prescription dose was 45 Gy (40 to 50 Gy in 4-5 fractions). Local relapse, defined as recurrence within the planning target volume was assessed with intravenous multiphase contrast computed tomography or magnetic resonance imaging every 4-6 mo after completion of SBRT. Progression of cirrhosis was evaluated by CP and Model for End Stage Liver Disease scores every 3-4 mo. Toxicities were graded per the Common Terminology Criteria for Adverse Events (v4.03). Median follow-up was 24 mo.RESULTSForty-nine HCC lesions among 40 patients were analyzed in this IRB approved retrospective study. Median tumor diameter was 3.5 cm (1.5-8.9 cm). Six patients with tumors ≥ 5 cm completed planned selected transarterial chemoembolization (TACE) in combination with SBRT. Eight patients underwent orthotropic live transplant (OLT) with SBRT as a bridging treatment (median time to transplant was 12 mo, range 5 to 23 mo). The Pathologic complete response (PCR) rate in this group was 62.5%. The 2-year in-field local control was 98% (1 failure). Intrahepatic control was 82% and 62% at 1 and 2 years, respectively. Overall survival (OS) was 92% and 60% at 1 and 2 years, with a median survival of 41 mo per Kaplan Meier analysis. At 1 and 2 years, 71% and 61% of patients retained CPA status. Of the patients with intrahepatic failures, 58% developed progressive cirrhosis, compared to 27% with controlled disease (P = 0.06). Survival specific to hepatic failure was 92%, 81%, and 69% at 12, 18, and 24 mo. There was no grade 3 or higher toxicity. On univariate analysis, gross tumor volume (GTV) < 23 cc was associated with freedom from CP progression (P = 0.05), hepatic failure-specific survival (P = 0.02), and trended with OS (P = 0.10).CONCLUSIONSBRT is safe and effective in HCC with early cirrhosis and may extend waiting time for transplant in patients who may not otherwise be immediate candidates.

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Section: Methodsmentioning

confidence: 99%

Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy

Hasan

Thai

Uemura

et al. 2017

WJGS

Self Cite

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“…In one retrospective study using 99m Tc-sulfur colloid SPECT-CT into the treatment planning process to avoid functional areas of the liver, the investigators observed no incidence of RILD, grade 3 or higher hepatic toxicity, or accelerated liver failure in HCC patients with advanced cirrhosis who completed liver SBRT 50, 51 . The outcomes in these studies are similar to prospective trials evaluating SBRT in HCC without functional treatment planning, where the incidence of grade 3 or higher hepatotoxicity ranged between 5% - 36% 7, 52, 53 .…”

Section: Functional Liver Imaging and Incorporation Into Radiation Plmentioning

confidence: 99%

Radiation-Induced Liver Disease and Modern Radiotherapy

Koay

Owen

Das

2018

Seminars in Radiation Oncology

102

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Modern radiotherapy techniques have enabled high focal doses of radiation to be delivered to patients with primary and secondary malignancies of the liver. The current clinical practice of radiation oncology has benefitted from decades of research that have informed how to achieve excellent local control and survival outcomes with minimal toxicities. Still, one of the most devastating consequences of radiation to the liver remains a challenge: radiation induced liver disease (RILD). Here, we will review the current understanding of classic and non-classic RILD from a clinical perspective, the evaluation and management of patients who are at risk of developing RILD, methods to reduce the likelihood of RILD using modern radiation techniques, and the diagnosis and treatment of radiation-related liver toxicities.

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“…There is also an increasing evidence base/clinical experience for the use of SABR in other primary cancer sites such as the prostate, pancreas, liver (metastases and primary hepatocellular carcinoma) and spinal metastases, and for oligometastatic disease. [4][5][6][7][8][9] In order to deliver ablative doses of RT to tumours, it is necessary to accurately identify both the target and the surrounding organs at risk (OARs), in addition to accommodating inter-and intrafraction movement of both. 10 The three key components required to achieve this involve patient immobilization, on-treatment image guidance and ontreatment patient motion management.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

Murray

Franks

Hanna

2017

The British Journal of Radiology

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Stereotactic ablative body radiotherapy (SABR) describes a radiotherapy (RT) technique where high doses of radiation are precisely delivered to an extracranial target within the body, using either a single fraction of RT or using multiple small numbers of fractions. SABR has now become the standard of care treatment for patients with early-stage non-small-cell lung cancer (NSCLC) for whom surgery is not appropriate. This systematic review considers the evidence supporting the use of SABR in early-stage NSCLC, reported toxicity rates, the use of SABR in centrally located NSCLC, the use of SABR as salvage therapy following surgery or RT, and future potential drug combinations with SABR.

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Stereotactic body radiotherapy (SBRT) with or without surgery for primary and metastatic liver tumors

Abstract: In this retrospective analysis we demonstrate that liver SBRT alone or in combination with surgery is safe and effective for the treatment of isolated inoperable hepatic malignancies and provides excellent local control rates.

Cited by 32 publications

References 37 publications

Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy

Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy

Radiation-Induced Liver Disease and Modern Radiotherapy

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

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