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Jang WI, Jo S, Moon JE, Bae SH, Park HC. The Current Evidence of Intensity-Modulated Radiotherapy for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:4914. [PMID: 37894281 PMCID: PMC10605127 DOI: 10.3390/cancers15204914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Intensity-modulated radiotherapy (IMRT), an advanced RT technique, is a considerable treatment option for hepatocellular carcinoma (HCC). However, the distinguishing features of IMRT for HCC have not yet been clearly defined. A systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The PubMed/MedLine, Embase, Cochrane Library, Web of Science, and KoreaMed were used to screen eligible studies focusing on treatment outcomes after IMRT for HCC until 18 April 2023. A total of 1755 HCC patients receiving IMRT among 29 studies from 2009 to 2023 were selected for the meta-analysis. The median proportion of Barcelona Clinic Liver Cancer stage C was 100% (range: 38-100%). Nineteen studies used combined treatment. Pooled rates of response and 1-year local control were 58% (95% confidence interval [CI], 50-65%) and 84% (95% CI, 70-94%), respectively. The median overall survival (OS) was 13 months (range: 5-45 months), and pooled 1- and 3-year OS rates were 59% (95% CI, 52-66%), and 23% (95% CI, 14-33%), respectively. Pooled rates of classic radiation-induced liver disease (RILD), nonclassic RILD, and hepatic toxicity ≥ grade 3 were 2%, 4%, and 4%, respectively. Although most patients had advanced-stage HCC and combined treatment was commonly used, IMRT for HCC showed similar survival to existing RT modalities and relatively low severe toxicity.
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Affiliation(s)
- Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea;
| | - Sunmi Jo
- Department of Radiation Oncology, Haeundae Paik Hospital, Inje University School of Medicine, 875, Haeun-daero, Haeundae-gu, Busan 48108, Republic of Korea;
| | - Ji Eun Moon
- Department of Biostatistics, Soonchunhyang University College of Medicine, Bucheon, 170 Jomaru-ro, Wongmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea;
| | - Sun Hyun Bae
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, 170 Jomaru-ro, Wongmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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Kim TH, Kim BH, Cho YR, Koh YH, Park JW. Feasibility of additional radiotherapy in patients with advanced hepatocellular carcinoma treated with atezolizumab plus bevacizumab. JOURNAL OF LIVER CANCER 2023; 23:330-340. [PMID: 37488926 PMCID: PMC10565546 DOI: 10.17998/jlc.2023.04.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND/AIM Radiotherapy (RT) is an effective local treatment for hepatocellular carcinoma (HCC). However, whether additional RT is safe and effective in patients with advanced HCC receiving atezolizumab plus bevacizumab remains unclear. This retrospective cohort study aimed to evaluate the feasibility of additional RT in these patients. METHODS Between March and October 2021, we retrospectively analyzed seven patients with advanced HCC who received RT during treatment with atezolizumab plus bevacizumab. The median prescribed RT dose was 35 Gy (range, 33-66). Freedom from local progression (FFLP), progression-free survival (PFS), and overall survival (OS) after RT were analyzed. RESULTS The median follow-up duration after RT was 14.2 months (range, 10.0-18.6). Of the seven patients, disease progression was noted in six (85.7%), the sites of disease progression were local in two (28.6%), intrahepatic in four (57.1%), and extrahepatic in four (57.1%). The median time of FFLP was not reached, and PFS and OS times were 4.0 (95% confidence interval [CI], 3.6-4.5) and 14.8% (95% CI, 12.5-17.2) months, respectively. The 1-year FFLP, PFS, and OS rates were 60% (95% CI, 43.8-76.2), 0%, and 85.7% (95% CI, 75.9-95.5), respectively. Grade 3 or higher hematologic adverse events (AEs) were not observed, but grade 3 nonhematologic AEs unrelated to RT were observed in one patient. CONCLUSIONS The addition of RT may be feasible in patients with advanced HCC treated with atezolizumab plus bevacizumab. However, further studies are required to validate these findings.
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Affiliation(s)
- Tae Hyun Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
- Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - Bo Hyun Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Yu Ri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Young-Hwan Koh
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Joong-Won Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
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Bae BK, Yu JI, Park HC, Goh MJ, Paik YH. Radiotherapy trend in elderly hepatocellular carcinoma: retrospective analysis of patients diagnosed between 2005 and 2017. Radiat Oncol J 2023; 41:98-107. [PMID: 37403352 DOI: 10.3857/roj.2023.00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/19/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE To report the trends of radiotherapy in the management of elderly patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS We retrospectively reviewed patients who entered HCC registry of Samsung Medical Center between 2005 and 2017. Patients who were 75 years or older at the time of registration were defined as elderly. They were categorized into three groups based on the year of registration. Radiotherapy characteristics were compared between the groups to observe differences by age groups and period of registration. RESULTS Out of 9,132 HCC registry patients, elderly comprised 6.2% (566 patients) of the registry, and the proportion increased throughout the study period (from 3.1% to 11.4%). Radiotherapy was administered to 107 patients (18.9%) in elderly group. Radiotherapy utilization in the early treatment process (within 1 year after registration) has rapidly increased from 6.1% to 15.3%. All treatments before 2008 were delivered with two-dimensional or three-dimensional conformal radiotherapy, while more than two-thirds of treatments after 2017 were delivered with advanced techniques such as intensity-modulated radiotherapy, stereotactic body radiotherapy, or proton beam therapy. Overall survival (OS) of elderly was significantly worse than younger patients. However, for patients who received radiotherapy during the initial management (within one month after registration), there was no statistically significant difference in OS between age groups. CONCLUSION The proportion of elderly HCC is increasing. Radiotherapy utilization and adoption of advanced radiotherapy technique showed a consistently increasing trend for the group of patients, indicating that the role of radiotherapy in the management of elderly HCC is expanding.
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Affiliation(s)
- Bong Kyung Bae
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Ji Goh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Yong-Han Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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SIB-IMRT combined with apatinib for unresectable hepatocellular carcinoma in patients with poor response to transarterial chemoembolization. Clin Res Hepatol Gastroenterol 2022; 46:101897. [PMID: 35240318 DOI: 10.1016/j.clinre.2022.101897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Radiotherapy combined with apatinib exhibits synergistic anti-tumor effect, while the application of simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) combined with apatinib in HCC patients is scarce. Hence, this study aimed to explore the treatment response, survival, and safety profile of the SIB-IMRT combined with apatinib in unresectable HCC (uHCC) patients. METHODS A total of 19 uHCC patients with deficient response to transarterial chemoembolization (TACE), who scheduled for SIB-IMRT combined with apatinib treatment were enrolled. The SIB-IMRT was applied at the following dose: 95% planning target volume (PTV) at 30-50 Gy/2-2.5 Gy/15-20f and 90% Boost of 45-72 Gy/3-4.5 Gy/15-20f at 5 times per week with cone beam computerized tomography validation. During and after radiotherapy, the apatinib was administrated orally with the initial dose of 500 mg per day. RESULTS The complete response, partial response, stable disease, and progressive disease rates were 31.6%, 36.8%, 21.1% and 10.5%, respectively. Consequently, the objective response rate and disease control rate were 68.4% and 89.5%, respectively. During a median follow-up duration of 9.0 months, the median progression-free survival (PFS) was 6.0 (95% confidential interval (CI): 4.9-7.1) months with 1-year PFS rate of 42.1%; the median overall survival (OS) was not reached with 1-year OS rate of 54.6%. The safety profile was acceptable with the most common adverse events including myelosuppression (42.1%), skin reaction (36.8%), and albuminuria (26.3%). CONCLUSION SIB-IMRT combined with apatinib exhibits a good efficacy and tolerable safety profile, which could be considered as a potential treatment choice for uHCC patients who have deficient response to TACE.
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Outcomes and Toxicities of Modern Combined Modality Therapy with Atezolizumab Plus Bevacizumab and Radiation Therapy for Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14081901. [PMID: 35454808 PMCID: PMC9032898 DOI: 10.3390/cancers14081901] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Atezolizumab plus bevacizumab has become frontline therapy for unresectable HCC. The compatibility of atezolizumab/bevacizumab with liver-directed RT has not been reported. Methods: HCC patients treated with liver-directed RT and atezolizumab/bevacizumab between 1/2020−11/2021 were included. Toxicity and outcomes were retrospectively recorded. For ALCs, we matched the analysis to a previously cohort of RT-treated HCC patients who did not receive atezolizumab/bevacizumab. Survival and time-to-liver-failure were analyzed using Kaplan−Meier. Results: Of 21 patients, with a median follow-up of 9.5 months, the median OS was 16.1 months. Post-RT, all patients had reduced tumors or treatment response. There were no ≥Grade 3 RT-related toxicities. Autoimmune complications occurred in two patients (9.5%), and GI bleeding in three patients (14.3%). Liver function remained stable post-RT. There was a marked decrease in ALCs immediately post-RT (post-RT/pre-RT ratio 47.3%, p < 0.0001), restored by 1 month to pre-treatment baseline (1-month post-RT/pre-RT ratio 95.1%, n.s.). Compared to HCC patients treated with RT alone, post-RT ALC recovery was faster with atezolizumab/bevacizumab (p = 0.009). Conclusion: In this first reported experience of RT with modern systemic therapy for HCC, combination therapy is safe and well-tolerated. As a favorable prognosticator, there appears to be faster recovery of ALC among patients who received RT with atezolizumab/bevacizumab.
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Masuda S, Tsukiyama T, Minagawa Y, Koizumi K, Kako M, Kinbara T, Haruki U. Hepatocellular carcinoma effective stereotactic body radiotherapy using Gold Anchor and the Synchrony system: Two case reports and review of literature. World J Clin Cases 2022; 10:2591-2603. [PMID: 35434047 PMCID: PMC8968590 DOI: 10.12998/wjcc.v10.i8.2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/12/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiotherapy for hepatocellular carcinoma (HCC) is considered to have limited efficacy because of treatment intensity considering that the irradiated area includes the liver, which is highly radiosensitive. In this report, we present two cases in which tumor control by surgical resection, radiofrequency ablation, transcatheter arterial chemoembolization (TACE), and lenvatinib administration was difficult, but stereotactic body radiotherapy (SBRT) using the Synchrony system by Radixact™ and Gold Anchor® (GA) was effective.
CASE SUMMARY A 60-year-old man had a single 10-cm HCC in the right lobe. Viable lesions remained after TACE, and levels of alpha-fetoprotein and protein induced by vitamin K antagonists II (PIVKA-II) decreased and quickly re-elevated. We performed SBRT with GA. Three weeks after implantation, localized radiotherapy (SBRT; 40 Gy/5 fractions) was performed using the Synchrony system by Radixact™. Four weeks later, the viable lesion had disappeared, and the PIVKA-II levels decreased. A 77-year-old man had a single 12-cm HCC in the right lobe. The patient experienced recurrence after hepatectomy. Further recurrence occurred after TACE, and we performed SBRT with GA. Because of the proximity of the HCC to the gastrointestinal tract, localized radiotherapy (SBRT; 39 Gy/13 fractions) to the HCC was performed 3 wk after implantation using the Synchrony system by Radixact™. Four weeks later, the viable lesion had disappeared on computed tomography, and the PIVKA-Ⅱ levels decreased.
CONCLUSION SBRT using the Synchrony system and GA can deliver a large dose accurately and safely, and could have a high therapeutic effect.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Toshitaka Tsukiyama
- Department of Interventional Radiology Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Yumiko Minagawa
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Makoto Kako
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Takeshi Kinbara
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Uojima Haruki
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
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Lee SU, Yoon SM, Cheng JCH, Kim TH, Kim BH, Park JH, Jung J, Tsai CL, Chiang Y, Park JW. Multi-Institutional Retrospective Study of Radiotherapy for Hepatocellular Carcinoma in the Caudate Lobe. Front Oncol 2021; 11:646473. [PMID: 33718247 PMCID: PMC7952981 DOI: 10.3389/fonc.2021.646473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background: No studies evaluating the clinical outcomes of radiotherapy (RT) for hepatocellular carcinoma (HCC) in the caudate lobe have been available to date. The purpose of this study was to evaluate the effectiveness and safety of RT for HCC in the caudate lobe. Material and Methods: Seventy patients with HCC in the caudate lobe treated with RT from a multi-institutional database were included in this study. The median equivalent dose in 2 Gy (EQD2) was 80.0 Gy10 (range, 31.3–99.3), and freedom from local progression (FFLP), progression-free survival (PFS), and overall survival (OS) rates were evaluated. Results: The median time of follow-up was 47.9 months (range, 3.4–127), and the 5-year FFLP, PFS, and OS rates were 80.6% [95% confidence interval (CI), 70.8–91.8], 13.8% (95% CI, 7.5–25.4), and 51.3% (95% CI, 39.9–66.1), respectively. In the multivariate analysis, the radiation dose was significantly associated with the FFLP rate [hazard ratio (HR), 0.57 per 10 Gy10 increase, p = 0.001], and the status of FFLP was significantly associated with OS (HR, 2.694, p = 0.014). The overall rate of ≥grade 3 adverse events was 5.7% (4 of 70), and RT-related mortality was not observed. Conclusion: RT for HCC in the caudate lobe showed promising FFLP and OS rates with safe toxicity profiles. These findings suggest that RT may be a promising treatment option for HCC in the caudate lobe.
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Affiliation(s)
- Sung Uk Lee
- Center for Proton Therapy, National Cancer Center, Goyang, South Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jason Chia-Hsien Cheng
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tae Hyun Kim
- Center for Proton Therapy, National Cancer Center, Goyang, South Korea.,Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea
| | - Bo Hyun Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chiao-Ling Tsai
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yun Chiang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Joong-Won Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea
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Abstract
External beam radiotherapy (EBRT) has improved efficacy and safety with advancements in technology and techniques. EBRT plays an important role in management of hepatocellular carcinoma (HCC). In resectable cases, EBRT serves as a bridge to transplantation or improves local control through adjuvant radiotherapy. In unresectable patients, EBRT offers high local control rates. In metastatic settings, EBRT provides effective palliation. This review presents an overview of radiotherapy treatment modalities used for HCC, current treatment guidelines for the role of EBRT in HCC, clinical outcomes between various EBRT approaches and other locoregional treatments for HCC, and the future role of EBRT for HCC.
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Affiliation(s)
- Chien Peter Chen
- Department of Radiation Oncology, Scripps Radiation Therapy Center, 10670 John Jay Hopkins Drive, San Diego, CA 92121, USA.
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Kim TH, Park JW, Kim BH, Oh ES, Youn SH, Moon SH, Kim SS, Woo SM, Koh YH, Lee WJ, Kim DY. Phase II Study of Hypofractionated Proton Beam Therapy for Hepatocellular Carcinoma. Front Oncol 2020; 10:542. [PMID: 32411594 PMCID: PMC7198869 DOI: 10.3389/fonc.2020.00542] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Proton beam has an excellent depth dose distribution due to its unique physical properties, and thus proton beam therapy (PBT) has been tried and showed promising outcomes in hepatocellular carcinoma (HCC). The purpose of this phase II study is to evaluate the efficacy of hypofractionated PBT in HCC. Methods: The eligibility criteria for this study were as follows: patients with HCC lesion(s) who were failed after, were difficult to treat with, or refused to other local treatments; tumor size and number of ≤7 and ≤2 cm, respectively, and HCC lesion(s) of ≥2 cm from gastrointestinal organs; Child–Pugh score of ≤7; Eastern Cooperative Oncology Group performance status ≤1; and age ≥18 years. The prescribed dose of PBT was 70 Gy equivalent in 10 fractions. The primary endpoint was 3-year local progression-free survival (LPFS) rate. Results: Forty-five patients were prospectively enrolled, and there were 35 men and 10 women with a median age of 63 years (range, 46–78 years). Thirty-seven patients had recurrent and/or residual disease, and eight patients had treatment-naive disease. All patients received the planned treatments without treatment interruption, and grade ≥3 acute toxicity did not occur. The median follow-up duration was 35.1 months (range, 11.2–56.3 months) and local progression occurred in two patients (8.7%). The 3-year rates of LPFS and overall survival (OS) were 95.2% (95% confidence interval [CI], 89.1%−100%) and 86.4% (95% CI, 72.9–99.9%), respectively. Conclusion: Hypofractionated PBT showed promising LPFS and OS, and further studies are warranted to compare PBT with other local modalities.
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Affiliation(s)
- Tae Hyun Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.,Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Joong-Won Park
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Bo Hyun Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Eun Sang Oh
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sang Hee Youn
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sung Ho Moon
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sang Soo Kim
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sang Myung Woo
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Young-Hwan Koh
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Woo Jin Lee
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Dae Yong Kim
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
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Chen CP. Role of Radiotherapy in the Treatment of Hepatocellular Carcinoma. J Clin Transl Hepatol 2019; 7:183-190. [PMID: 31293919 PMCID: PMC6609847 DOI: 10.14218/jcth.2018.00060] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 04/27/2019] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
The role of radiotherapy in the treatment of hepatocellular carcinoma (HCC) has evolved over the past few decades with the advancement of technology and improved imaging. Radiotherapy can offer high local control rates in unresectable HCC, including cases with major vascular involvement, and can provide a modality to help bridge patients to potentially curative resection or transplantation. In metastatic cases, radiotherapy can provide good palliation. This review focuses on the common radiotherapy treatment modalities used for HCC, provides outcome comparisons of these radiotherapy techniques to outcomes with other treatment modalities for HCC, and highlights the discrepancy of the role of radiotherapy in HCC amongst the current available treatment guidelines.
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Affiliation(s)
- Chien Pong Chen
- Correspondence to: Chien Pong Chen, Department of Radiation Oncology, Scripps MD Anderson Cancer Center, 10670 John Jay Hopkins Drive, San Diego, CA 92121, USA. Tel: +1-858-554-4100, E-mail:
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11
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Dose escalation by intensity modulated radiotherapy in liver-directed concurrent chemoradiotherapy for locally advanced BCLC stage C hepatocellular carcinoma. Radiother Oncol 2019; 133:1-8. [DOI: 10.1016/j.radonc.2018.12.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/22/2022]
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12
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Kim TH, Park JW, Kim BH, Kim H, Moon SH, Kim SS, Woo SM, Koh YH, Lee WJ, Kim DY, Kim CM. Does Risk-Adapted Proton Beam Therapy Have a Role as a Complementary or Alternative Therapeutic Option for Hepatocellular Carcinoma? Cancers (Basel) 2019; 11:cancers11020230. [PMID: 30781391 PMCID: PMC6406298 DOI: 10.3390/cancers11020230] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/30/2019] [Accepted: 02/12/2019] [Indexed: 02/08/2023] Open
Abstract
To evaluate the role of risk-adapted proton beam therapy (PBT) in hepatocellular carcinoma (HCC) patients, a total of 243 HCC patients receiving risk-adapted PBT with three dose-fractionation regimens (regimen A [n = 40], B [n = 60], and C [n = 143]) according to the proximity of their gastrointestinal organs (<1 cm, 1–1.9 cm, and ≥2 cm, respectively) were reviewed: The prescribed doses to planning target volume 1 (PTV1) were 50 gray equivalents (GyE) (EQD2 [equivalent dose in 2 Gy fractions], 62.5 GyE10), 60 GyE (EQD2, 80 GyE10), and 66 GyE (EQD2, 91.3 GyE10) in 10 fractions, respectively, and those of PTV2 were 30 GyE (EQD2, 32.5 GyE10) in 10 fractions. In all patients, the five-year local recurrence-free survival (LRFS) and overall survival (OS) rates were 87.5% and 48.1%, respectively, with grade ≥3 toxicity of 0.4%. In regimens A, B, and C, the five-year LRFS and OS rates were 54.6%, 94.7%, and 92.4% (p < 0.001), and 16.7%, 39.2%, and 67.9% (p < 0.001), respectively. The five-year OS rates of the patients with the Modified Union for International Cancer Control (mUICC) stages I, II, III, and IVA and Barcelona Clinic Liver Cancer (BCLC) stages A, B, and C were 69.2%, 65.4%, 43.8%, and 26.6% (p < 0.001), respectively, and 65.1%, 40%, and 32.2% (p < 0.001), respectively. PBT could achieve promising long-term tumor control and have a potential role as a complementary or alternative therapeutic option across all stages of HCC.
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Affiliation(s)
- Tae Hyun Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
| | - Joong-Won Park
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
| | - Bo Hyun Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
| | - Hyunjung Kim
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
| | - Sung Ho Moon
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
| | - Sang Soo Kim
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
| | - Sang Myung Woo
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
| | - Young-Hwan Koh
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
| | - Woo Jin Lee
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
| | - Dae Yong Kim
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
| | - Chang-Min Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea.
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13
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Lo YC, Hsu FC, Hung SK, Tseng KC, Hsieh YH, Lee MS, Tseng CW, Lin HY, Chen LC, Chiou WY. Prognosticators of hepatocellular carcinoma with intrahepatic vascular invasion. Tzu Chi Med J 2019; 31:40-46. [PMID: 30692831 PMCID: PMC6334563 DOI: 10.4103/tcmj.tcmj_14_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: The prognosis of intrahepatic vascular invasion, including unilateral or main portal vein tumor thrombosis (PVTT) and hepatic vein thrombosis, is still poor. Many patients with intrahepatic vascular invasions never receive radiotherapy (RT). In recent years, more conformal RT techniques such as intensity-modulated RT (IMRT) have been developed and applied to treat other cancers and have significantly improved treatment results and decreased side effects. The purpose of this study is to evaluate the treatment results in patients with intrahepatic vascular invasion and explore the role of IMRT in these treatments. Materials and Methods: There were a total of 73 patients with newly diagnosed AJCC stage IIIB hepatocellular carcinoma (HCC), with either PVTT or hepatic vein tumor thrombosis between 2007 and 2015 in our hospital. IMRT was used for all patients who received RT. Prognostic factors, including treatment modalities, liver function, and comorbidities, were analyzed using univariate and multivariate analysis with the Cox model. Survival time was analyzed using the Kaplan–Meier method. Results: The longest follow-up time was 45.3 months. The median age was 67 years. Univariate analyses indicated that IMRT, transarterial chemoembolization (TACE), target therapy (sorafenib), tumor size, Child-Pugh class, and ascites were significantly associated with overall survival (OS). In multivariate analysis, IMRT (hazard ratio [HR], 0.495; P = 0.019), sorafenib (HR, 0.340; P = 0.013), tumor size (HR, 2.085; P = 0.020), and Child-Pugh class (P = 0.004), were independent prognostic predictors for patients with intrahepatic vessel invasion, but TACE and ascites were not. The outcomes of patients who had different treatment modalities were significantly different (P < 0.001). Patients who received IMRT with TACE had the best outcomes. Patients who received an RT dose above 5400 cGy had better outcomes than those who with a dose below 5400 cGy, although the results were not significantly different (P = 0.248). Conclusion: IMRT is an important treatment component for patients with intrahepatic vascular invasion. Combined treatment modalities, such as IMRT with TACE, could improve the outcomes of HCC patients with intrahepatic vessel invasion.
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Affiliation(s)
- Yuan-Chen Lo
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Feng-Chun Hsu
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Shih-Kai Hung
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Kuo-Chih Tseng
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yu-His Hsieh
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Moon-Sing Lee
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Wei Tseng
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Hon-Yi Lin
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Liang-Cheng Chen
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Wen-Yen Chiou
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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14
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Kim TH, Lee WJ, Woo SM, Kim H, Oh ES, Lee JH, Han SS, Park SJ, Suh YG, Moon SH, Kim SS, Kim DY. Effectiveness and Safety of Simultaneous Integrated Boost-Proton Beam Therapy for Localized Pancreatic Cancer. Technol Cancer Res Treat 2018; 17:1533033818783879. [PMID: 29962281 PMCID: PMC6048612 DOI: 10.1177/1533033818783879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: To evaluate the clinical effectiveness and feasibility of simultaneous integrated
boost-proton beam therapy in patients with localized pancreatic cancer. Methods: Thirty-seven patients with localized pancreatic cancer underwent simultaneous
integrated boost-proton beam therapy, and 8 (21.6%) patients received induction
chemotherapy. The internal target volume was obtained by summing the gross tumor volumes
in exhalation phase computed tomography images. Planning target volume 1 included
internal target volume plus 3 to 5 mm margins, excluding the 5 mm expanded volume of
gastrointestinal structures, and planning target volume 2 included the internal target
volume plus 7 to 12 mm margins. The prescribed doses to planning target volume 1 and
planning target volume 2 were 45 GyE (equivalent dose in 2 Gy, 54.4 GyE10)
and 30 GyE (equivalent dose in 2 Gy, 32.5 GyE10) in 10 fractions,
respectively. Results: Overall, treatment was well tolerated, with no grade of toxicity ≥3. Median overall
survival was 19.3 months, and 1-year local progression-free survival, relapse-free
survival, and overall survival rates were 64.8%, 33.2%, and 75.7%, respectively.
Patients treated with simultaneous integrated boost-proton beam therapy after induction
chemotherapy had a significantly higher median overall survival time compared to those
with simultaneous integrated boost-proton beam therapy alone (21.6 months vs 16.7
months, P = .031). Multivariate analysis showed that induction
chemotherapy was a significant factor for overall survival (P <
.05). Conclusions: Simultaneous integrated boost-proton beam therapy could be feasible and promising for
patients with localized pancreatic cancer.
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Affiliation(s)
- Tae Hyun Kim
- 1 Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.,2 Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Woo Jin Lee
- 1 Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sang Myung Woo
- 1 Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Hyunjung Kim
- 2 Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Eun Sang Oh
- 2 Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Ju Hee Lee
- 1 Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sung-Sik Han
- 1 Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Jae Park
- 1 Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Yang-Gun Suh
- 2 Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sung Ho Moon
- 2 Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sang Soo Kim
- 2 Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Dae Yong Kim
- 2 Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
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15
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Oh ES, Kim TH, Woo SM, Lee WJ, Lee JH, Youn SH, Han SS, Park SJ, Kim DY. Effectiveness and feasibility of concurrent chemoradiotherapy using simultaneous integrated boost-intensity modulated radiotherapy with and without induction chemotherapy for locally advanced pancreatic cancer. Radiat Oncol J 2018; 36:200-209. [PMID: 30309211 PMCID: PMC6226140 DOI: 10.3857/roj.2018.00073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/23/2018] [Indexed: 11/09/2022] Open
Abstract
Purpose To evaluate the effectiveness and feasibility of chemoradiotherapy (CRT) using simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in locally advanced pancreatic cancer (LAPC) patients. Materials and Methods Between January 2011 and May 2015, 47 LAPC patients received CRT using SIB-IMRT. Prior to SIB-IMRT, 37 patients (78.7%) received induction chemotherapy (IC-CRT group) and remaining 10 patients (21.3%) did not received induction chemotherapy (CRT group). During SIB-IMRT, all patients received concomitant chemotherapy, with gemcitabine (n = 37) and capecitabine (n = 10). Results At the time of analysis, 45 patients had died and 2 patients remained alive and the median follow-up time was 14.2 months (range, 3.3 to 51.4 months). For all patients, the median times of local progression-free survival (LPFS), progression-free survival (PFS), and overall survival (OS) were 18.1, 10.3, and 14.2 months, respectively. The median time of LPFS between IC-CRT and CRT groups was similar (18.1 months vs. 18.3 months, p = 0.711). IC-CRT group had a higher trend in PFS (10.9 months vs. 4.1 months, p = 0.054) and had significantly higher OS (15.4 months vs. 9.5 months, p = 0.007) than CRT group. In multivariate analysis, the use of induction chemotherapy and tumor response were significant factors associated with OS (p < 0.05, each). During SIBIMRT, toxicity of grade ≥3 was observed in 7 patients (14.9%) in all patients. Conclusions CRT using SIB-IMRT is feasible and promising in LAPC patients.
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Affiliation(s)
- Eun Sang Oh
- Proton Therapy Center, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea
| | - Tae Hyun Kim
- Proton Therapy Center, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea
- Correspondence: Tae Hyun Kim, MD, Proton Therapy Center, National Cancer Center Research Institute and Hospital, National Cancer Institute, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea. Tel: +82-31-920-1725, Fax: +82-31-920-0149, E-mail:
| | - Sang Myung Woo
- Center for Liver Cancer, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea
| | - Woo Jin Lee
- Center for Liver Cancer, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea
| | - Ju Hee Lee
- Center for Liver Cancer, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea
| | - Sang Hee Youn
- Proton Therapy Center, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea
| | - Sung Sik Han
- Center for Liver Cancer, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea
| | - Sang Jae Park
- Center for Liver Cancer, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea
| | - Dae Yong Kim
- Proton Therapy Center, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea
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16
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Rim CH, Yoon WS. Leaflet manual of external beam radiation therapy for hepatocellular carcinoma: a review of the indications, evidences, and clinical trials. Onco Targets Ther 2018; 11:2865-2874. [PMID: 29844684 PMCID: PMC5962257 DOI: 10.2147/ott.s164651] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The use of external beam radiation therapy (EBRT) in the treatment of hepatocellular carcinoma (HCC), which was rarely performed due to liver toxicity with a previous technique, has increased. Palliation of portal vein thrombosis, supplementation for insufficient transarterial chemoembolization, and provision of new curative opportunities using stereotactic body radiotherapy are the potential indications for use of EBRT. The mechanism of EBRT treatment, with its radiobiological and physical perspectives, differs from those of conventional medical treatment or surgery. Therefore, understanding the effects of EBRT may be unfamiliar to physicians other than radiation oncologists, especially in the field of HCC, where EBRT has recently begun to be applied. The first objective of this review was to concisely explain the indications for use of EBRT for HCC for all physicians treating HCC. Therefore, this review focuses on the therapeutic outcomes rather than the detailed biological and physical background. We also reviewed recent clinical trials that may extend the indications for use of EBRT. Finally, we reviewed the current clinical practice guidelines for the treatment of HCC and discuss the current recommendations and future perspectives.
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Affiliation(s)
- Chai Hong Rim
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Republic of Korea
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17
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Kim TH, Park JW, Kim BH, Kim DY, Moon SH, Kim SS, Lee JH, Woo SM, Koh YH, Lee WJ, Kim CM. Optimal time of tumour response evaluation and effectiveness of hypofractionated proton beam therapy for inoperable or recurrent hepatocellular carcinoma. Oncotarget 2017; 9:4034-4043. [PMID: 29423102 PMCID: PMC5790519 DOI: 10.18632/oncotarget.23428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 11/26/2017] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the optimal time of tumour response and effectiveness of hypofractionated proton beam therapy (PBT) for hepatocellular carcinoma (HCC). Results Overall, treatment was well tolerated with no grade toxicity ≥3. Of 71 patients, 66 patients (93%) eventually reached complete response (CR) after PBT: 93.9% (62 of 66) of patients who reached CR within 12 months, and the remaining 4 patients (6.1%) reached CR at 12.5, 16.2, 19.1 and 21.7 months, respectively. The three-year local progression-free survival (LPFS), relapse-free survival (RFS) and OS rates were 89.9%, 26.8%, and 74.4%, respectively. Multivariate analysis revealed that the tumour response was an independent prognostic factor for LPFS, RFS, and OS. Conclusion Most CR was achieved within 1 year after PBT and further salvage treatments in PBT field might be postponed up to approximately 18–24 months. Hypofractionated PBT could be good alternative for HCC patients who are unsuitable for surgical or invasive treatments with curative intent. Materials and Methods Seventy-one inoperable or recurrent HCC patients underwent hypofractionated PBT using 66 GyE in 10 fractions. The tumour responses were defined as the maximal tumour response observed during the follow-up period using the modified Response Evaluation Criteria in Solid Tumors criteria.
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Affiliation(s)
- Tae Hyun Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Joong-Won Park
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Bo Hyun Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Yong Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Ho Moon
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang Soo Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ju Hee Lee
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang Myung Woo
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Young-Hwan Koh
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Woo Jin Lee
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chang-Min Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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18
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Kim Y, Park HC, Yoon SM, Kim TH, Lee J, Choi J, Yu JI, Park JH, Kim JH, Park JW, Seong J. Prognostic group stratification and nomogram for predicting overall survival in patients who received radiotherapy for abdominal lymph node metastasis from hepatocellular carcinoma: a multi-institutional retrospective study (KROG 15-02). Oncotarget 2017; 8:94450-94461. [PMID: 29212241 PMCID: PMC5706887 DOI: 10.18632/oncotarget.21775] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/20/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To develop a prognostic model for overall survival (OS) in hepatocellular carcinoma (HCC) patients receiving radiotherapy (RT) to metastatic abdominal lymph nodes (LNs). MATERIALS AND METHODS Two hundred twenty-eight patients treated with RT to metastatic abdominal LNs were retrospectively reviewed. RESULTS Median OS in all patients was 11.1 months. LN responders had significantly higher median OS than non-responders (14.2 months vs. 7.5 months, p<0.05). On multivariate analysis, Child-Pugh classification, status of intrahepatic tumor, presence of distant metastasis, number and location of metastatic LNs, serum level of alpha fetoprotein (AFP), and the LN response to RT were significant prognostic factors for OS (p < 0.05 each). Based on the results of multivariate analysis, prognostic group stratification according to the number of pre-treatment risk factors was a significant predictor of OS, and median OS in patients with ≥ 4, 3, 2, 1, and 0 risk factors were 2.9, 5.5, 10.3, 13.6, and 27.8 months, respectively (p<0.05). A nomogram was formulated by integrating the different prognostic contribution of each factor, and it showed good accuracy for predicting 2-year OS with a concordance index of 0.72. CONCLUSION Prognostic group stratification and nomogram could be useful prognostic and therapeutic indicators in selecting treatment strategies.
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Affiliation(s)
- Youngkyong Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hyun Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Jieun Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinhyun Choi
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Hoon Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joong-Won Park
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
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19
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Bae SH, Jang WI, Park HC. Intensity-modulated radiotherapy for hepatocellular carcinoma: dosimetric and clinical results. Oncotarget 2017; 8:59965-59976. [PMID: 28938697 PMCID: PMC5601793 DOI: 10.18632/oncotarget.19219] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/02/2017] [Indexed: 12/15/2022] Open
Abstract
Since the introduction of 3-dimensional conformal radiotherapy (3DCRT), new radiotherapy techniques have expanded the indication of radiotherapy for the treatment of hepatocellular carcinoma (HCC), from the hitherto palliative to a now curative-intent purpose. Intensity-modulated radiotherapy (IMRT), currently the most advanced radiotherapy technique, is considered an attractive option for the treatment of HCC, and is more widely applied because it can deliver a higher dose to the tumor than 3DCRT while sparing surrounding normal organs. However, the advantages and potential disadvantages of IMRT for treating HCC have not been fully established. This article deals with three different IMRT techniques, including static IMRT and volumetric modulated arc therapy using conventional multileaf collimator (MLC) mounted linear accelerators, and helical IMRT using binary MLC mounted helical tomotherapy machine. We review dosimetric and clinical studies for these IMRT techniques for the treatment of HCC.
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Affiliation(s)
- Sun Hyun Bae
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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20
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Kim DY, Park JW, Kim TH, Kim BH, Moon SH, Kim SS, Woo SM, Koh YH, Lee WJ, Kim CM. Risk-adapted simultaneous integrated boost-proton beam therapy (SIB-PBT) for advanced hepatocellular carcinoma with tumour vascular thrombosis. Radiother Oncol 2016; 122:122-129. [PMID: 28034460 DOI: 10.1016/j.radonc.2016.12.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/09/2016] [Accepted: 12/08/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate clinical effectiveness and safety of simultaneous integrated boost-proton beam therapy (SIB-PBT) in hepatocellular carcinoma (HCC) patients with tumour vascular thrombosis (TVT). MATERIAL AND METHODS Forty-one HCC patients with TVT underwent SIB-PBT using three dose-fractionation schemes: if gross tumour volume <1cm (n=27), 1-1.9cm (n=7), and ⩾2cm (n=7) from gastrointestinal structures, 50GyE (EQD2, 62.5GyE10), 60Gy (EQD2, 80GyE10), 66Gy (EQD2, 91.3GyE10), respectively, in 10 fractions was prescribed to planning target volume 1 (PTV1), and 30GyE (EQD2, 32.5GyE10) in 10 fractions was prescribed to PTV2. RESULTS Overall, treatment was well tolerated, with no grade toxicity ⩾3. Median overall survival (OS) was 34.4months and 2-year local progression-free survival (LPFS), relapse free survival (RFS), and OS rates were 88.1%, 25%, and 51.1%, respectively. Patients treated with EQD2 of ⩾80GyE10 tended to show better TVT response (92.8% vs. 55.5%, p=0.002) 2-year LPFS (92.9% vs. 82.5%, p=0.463), RFS (28.8% vs. 19%, p=0.545), and OS (58.4% vs. 46.8%, p=0.428) rates than those with EQD2 of <80GyE10. Multivariate analysis showed that TVT response and Child Pugh classification were independent prognostic factors for OS. CONCLUSIONS SIB-PBT is feasible and promising for HCC patients with TVT.
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Affiliation(s)
- Dae Yong Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Joong-Won Park
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Tae Hyun Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
| | - Bo Hyun Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sung Ho Moon
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sang Soo Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sang Myung Woo
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Young-Hwan Koh
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Woo Jin Lee
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Chang-Min Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
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21
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Park SH, Kim JC, Kang MK. Technical advances in external radiotherapy for hepatocellular carcinoma. World J Gastroenterol 2016; 22:7311-21. [PMID: 27621577 PMCID: PMC4997637 DOI: 10.3748/wjg.v22.i32.7311] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/21/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy techniques have substantially improved in the last two decades. After the introduction of 3-dimensional conformal radiotherapy, radiotherapy has been increasingly used for the treatment of hepatocellular carcinoma (HCC). Currently, more advanced techniques, including intensity-modulated radiotherapy (IMRT), stereotactic ablative body radiotherapy (SABR), and charged particle therapy, are used for the treatment of HCC. IMRT can escalate the tumor dose while sparing the normal tissue even though the tumor is large or located near critical organs. SABR can deliver a very high radiation dose to small HCCs in a few fractions, leading to high local control rates of 84%-100%. Various advanced imaging modalities are used for radiotherapy planning and delivery to improve the precision of radiotherapy. These advanced techniques enable the delivery of high dose radiotherapy for early to advanced HCCs without increasing the radiation-induced toxicities. However, as there have been no effective tools for the prediction of the response to radiotherapy or recurrences within or outside the radiation field, future studies should focus on selecting the patients who will benefit from radiotherapy.
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22
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Park HC, Yu JI, Cheng JCH, Zeng ZC, Hong JH, Wang MLC, Kim MS, Chi KH, Liang PC, Lee RC, Lau WY, Han KH, Chow PKH, Seong J. Consensus for Radiotherapy in Hepatocellular Carcinoma from The 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014): Current Practice and Future Clinical Trials. Liver Cancer 2016; 5:162-74. [PMID: 27493892 PMCID: PMC4960352 DOI: 10.1159/000367766] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A consensus meeting to develop practice guidelines and to recommend future clinical trials for radiation therapy (RT), including external beam RT (EBRT), and selective internal RT (SIRT) in hepatocellular carcinoma (HCC) was held at the 5th annual meeting of the Asia-Pacific Primary Liver Cancer Expert consortium. Although there is no randomized phase III trial evidence, the efficacy and safety of RT in HCC has been shown by prospective and retrospective studies using modern RT techniques. Based on these results, the committee came to a consensus on the utility and efficacy of RT in the management of HCC according to each disease stage as follows: in early and intermediate stage HCC, if standard treatment is not compatible, RT, including EBRT and SIRT can be considered. In locally advanced stage HCC, combined EBRT with transarterial chemoembolization or hepatic arterial infusion chemotherapy, and SIRT can be considered. In terminal stage HCC, EBRT can be considered for palliation of symptoms and reduction of morbidity caused by the primary tumor or its metastases. Despite the currently reported benefits of RT in HCC, the committee agreed that there is a compelling need for large prospective studies, including randomized phase III trial evidence evaluating the role of RT. Specifically studies evaluating the efficacy and safety of sequential combination of EBRT and SIRT are strongly recommended.
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Affiliation(s)
- Hee Chul Park
- Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,Medical Device Management and Research, SAIHST, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Il Yu
- Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jason Chia-Hsien Cheng
- Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| | - Zhao Chong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ji Hong Hong
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (ROC)
| | | | - Mi Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Kwan Hwa Chi
- Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (ROC)
| | - Po-Ching Liang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan (ROC)
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (ROC)
| | - Wan-Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Kwang Hyub Han
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pierce Kah-Hoe Chow
- Department of Surgical Oncology, National Cancer Center; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital; Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore,*Pierce K. H. Chow, MD, PhD, Department of Surgical Oncology, National Cancer, Center, Department of Hepatopancreatobiliary and, Transplant Surgery, Singapore General Hospital;, Office of Clinical Sciences, Duke-NUS Graduate, Medical School, Singapore (Singapore), Tel. +65 6326 6091, E-Mail
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea,*Jinsil Seong, MD, PhD, Department of Radiation Oncology, Yonsei Cancer, Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, (Republic of Korea), Tel. +82 2 2228 8111, E-Mail
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23
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Cha H, Park HC, Yu JI, Kim TH, Nam TK, Yoon SM, Yoon WS, Kim JW, Kim MS, Jang HS, Choi Y, Kim JH, Kay CS, Jung I, Seong J. Clinical Practice Patterns of Radiotherapy in Patients with Hepatocellular Carcinoma: A Korean Radiation Oncology Group Study (KROG 14-07). Cancer Res Treat 2016; 49:61-69. [PMID: 27338036 PMCID: PMC5266383 DOI: 10.4143/crt.2016.097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 05/17/2015] [Indexed: 12/31/2022] Open
Abstract
Purpose The aim of this study was to examine patterns of radiotherapy (RT) in Korean patients with hepatocellular carcinoma (HCC) according to the evolving guideline for HCC established by the Korean Liver Cancer Study Group-National Cancer Center (KLCSG-NCC). Materials and Methods We reviewed 765 patients with HCC who were treated with RT between January 2011 and December 2012 in 12 institutions. Results The median follow-up period was 13.3 months (range, 0.2 to 51.7 months). Compared with previous data between 2004 and 2005, the use of RT as a first treatment has increased (9.0% vs. 40.8%). Increased application of intensity-modulated RT resulted in an increase in radiation dose (fractional dose, 1.8 Gy vs. 2.5 Gy; biologically effective dose, 53.1 Gy10 vs. 56.3 Gy10). Median overall survival was 16.2 months, which is longer than that reported in previous data (12 months). In subgroup analysis, treatments were significantly different according to stage (p < 0.001). Stereotactic body RT was used in patients with early HCC, and most patients with advanced stage were treated with three-dimensional conformal RT. Conclusion Based on the evolving KLCSG-NCC practice guideline for HCC, clinical practice patterns of RT have changed. Although RT is still used mainly in advanced HCC, the number of patients with good performance status who were treated with RT as a first treatment has increased. This change in practice patterns could result in improvement in overall survival.
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Affiliation(s)
- Hyejung Cha
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.,Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyun Kim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Taek-Keun Nam
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Hong Seok Jang
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngmin Choi
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chul Seung Kay
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Inkyung Jung
- Department of Biostatistics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Lee DY, Park JW, Kim TH, Lee JH, Kim BH, Woo SM, Kim SS, Lee WJ, Kim DY, Kim CM. Prognostic indicators for radiotherapy of abdominal lymph node metastases from hepatocellular carcinoma. Strahlenther Onkol 2015; 191:835-44. [PMID: 26174506 DOI: 10.1007/s00066-015-0873-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/23/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To identify prognostic indicators in patients treated with radiotherapy (RT) for metastases from hepatocellular carcinoma (HCC) in abdominal lymph nodes (LNs). PATIENTS AND METHODS RT was used to treat 65 patients for metastases from HCC in abdominal LNs. Total radiation dose was 30-60 Gy (median 52.8 Gy), with fraction size 1.8-3 Gy. RT was administered five times per week to an equivalent dose in 2-Gy fractions (EQD2; Gy10) of 32.5-65 Gy10 (median 54 Gy10) and an α/βratio for tumor and acute effects of normal tissue of 10. RESULTS Median overall survival (OS) in all patients was 8.1 months. LN responders had significantly higher median OS than nonresponders (14.5 vs. 3.7 months, p < 0.05). Multivariate analysis showed that Child-Pugh classification, status of intrahepatic tumor, number of metastatic LNs, and LN response were independently predictive of OS (p < 0.05 each). Based on results of multivariate analysis, patients were prognostically stratified according to pretreatment risk factors, including Child-Pugh classification, intrahepatic tumor status, and number of metastatic LNs; with the expected median OS in patients with ≥ 2, 1, and 0 risk factors being 2.9, 9.8, and 27.6 months, respectively (p < 0.05). CONCLUSION Our data showed that LN response to RT was an independent prognostic factor for OS in advanced HCC patients with abdominal LN metastases, and suggested that RT for metastatic LNs might improve OS in these patients. In addition, our data suggest that Child-Pugh classification, intrahepatic tumor status, and number of metastatic LNs may be useful prognostic and therapeutic indicators for selecting treatment strategies.
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Affiliation(s)
- Doo Yeul Lee
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea, Goyang, Korea
| | - Joong-Won Park
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea, Goyang, Korea
| | - Tae Hyun Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea, Goyang, Korea.
| | - Ju Hee Lee
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea, Goyang, Korea
| | - Bo Hyun Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea, Goyang, Korea
| | - Sang Myung Woo
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea, Goyang, Korea
| | - Sang Soo Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea, Goyang, Korea
| | - Woo Jin Lee
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea, Goyang, Korea
| | - Dae Yong Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea, Goyang, Korea
| | - Chang-Min Kim
- Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea, Goyang, Korea
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Qi WX, Fu S, Zhang Q, Guo XM. Charged particle therapy versus photon therapy for patients with hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol 2014; 114:289-95. [PMID: 25497556 DOI: 10.1016/j.radonc.2014.11.033] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/03/2014] [Accepted: 11/20/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE To perform a systematic review and meta-analysis to compare the clinical outcomes and toxicity of hepatocellular carcinoma (HCC) patients treated with charged particle therapy (CPT) with those of individuals receiving photon therapy. METHODS We identified relevant clinical studies through searching databases. Primary outcomes of interest were overall survival (OS) at 1, 3, 5 years, progression-free survival (PFS), and locoregional control (LC) at longest follow-up. RESULTS 73 cohorts from 70 non-comparative observational studies were included. Pooled OS was significantly higher at 1, 3, 5 years for CPT than for conventional radiotherapy (CRT) [relative risk (RR) 1·68, 95% CI 1·22-2·31; p<0·001; RR 3.46, 95% CI: 1.72-3.51, p<0.001; RR 25.9, 95% CI: 1.64-408.5, p=0.02; respectively]. PFS and LC at longest follow-up was also significantly higher for CPT than for CRT (p=0·013 and p<0.001, respectively), while comparable efficacy was found between CPT and SBRT in terms of OS, PFS and LC at longest follow-up. Additionally, high-grade acute and late toxicity associated with CPT was lower than that of CRT and SBRT. CONCLUSION Survival rates for CPT are higher than those for CRT, but similar to SBRT in patients with HCC. Toxicity tends to be lower for CPT compared to photon radiotherapy.
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Affiliation(s)
- Wei-Xiang Qi
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, China
| | - Shen Fu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China.
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, China
| | - Xiao-Mao Guo
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China
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CT-guided high-dose-rate brachytherapy of unresectable hepatocellular carcinoma. Strahlenther Onkol 2014; 191:405-12. [DOI: 10.1007/s00066-014-0781-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 10/30/2014] [Indexed: 12/12/2022]
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