1
|
Recurrence of hepatocellular carcinoma after radiofrequency ablation in a poor-risk patient with chronic renal failure and other complications successfully treated with stereotactic body radiotherapy. Clin J Gastroenterol 2022; 16:216-223. [PMID: 36445620 DOI: 10.1007/s12328-022-01734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/04/2022] [Indexed: 11/30/2022]
Abstract
The patient was an 85-year-old man with hepatitis C-related liver cirrhosis and chronic renal failure caused by diabetes mellitus under maintenance hemodialysis (HD) who developed hepatocellular carcinoma (HCC) after achieving a sustained viral response with direct acting antiviral therapy 1 year and 3 months previously. HCC located near the right hepatic vein was treated by radiofrequency ablation (RFA) but recurrent disease accompanied by hepatic vein invasion was detected 3 months after RFA. The recurrent HCC was curatively treated with stereotactic body radiotherapy (SBRT). The patient had additional complications, including grade III AV block controlled by a pacemaker, colonic adenoma resected by endoscopic mucosal resection, and a small cerebral aneurysm, which was untreated. At 2 years after SBRT, there had been no recurrence of HCC. In this old HCC patient with various complications including HD with polypharmacy, multidisciplinary treatment, including SBRT, enabled the patient to achieve complete remission and maintain a good quality of life.
Collapse
|
2
|
Lewis S, Dawson L, Barry A, Stanescu T, Mohamad I, Hosni A. Stereotactic body radiation therapy for hepatocellular carcinoma: from infancy to ongoing maturity. JHEP Rep 2022; 4:100498. [PMID: 35860434 PMCID: PMC9289870 DOI: 10.1016/j.jhepr.2022.100498] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Shirley Lewis
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Laura Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Aisling Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Teodor Stanescu
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Centre, Jordan
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Canada
- Corresponding author. Address: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.
| |
Collapse
|
3
|
Pérez-Romasanta LA, González-Del Portillo E, Rodríguez-Gutiérrez A, Matías-Pérez Á. Stereotactic Radiotherapy for Hepatocellular Carcinoma, Radiosensitization Strategies and Radiation-Immunotherapy Combination. Cancers (Basel) 2021; 13:cancers13020192. [PMID: 33430362 PMCID: PMC7825787 DOI: 10.3390/cancers13020192] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Radiotherapy is rapidly turning into a crucial component of multidisciplinary treatment for liver cancer because many patients are not surgical treatment candidates. Thanks to technical developments, radiotherapy have achieved high precision treatments, making it possible to eliminate tumor cells without severe damage to the liver and other organs. Stereotactic Body Radiation Therapy is an advanced radiotherapy technique able to eradicate malignant tumors wherever they are located in properly selected patients. The best use of radiotherapy, the most fruitful radiotherapy strategy, and the best way to combine it with other treatments for liver cancer are largely unknown. Radiosensitizers, agents that can potentiate radiotherapy, could broaden the radiotherapeutic landscape. Radiotherapy potentiation can be achieved with diverse treatments, not only drugs but also nanoparticles. In order to clear up the performance of radiotherapy in liver cancer management in the future and the best ways to potentiate its effects, considerable medical research is needed. Abstract Stereotactic body radiotherapy (SBRT) is an emerging ablative modality for hepatocellular carcinoma (HCC). Most patients with HCC have advanced disease at the time of diagnosis, and therefore, are not candidates for definitive-intent therapies such as resection or transplantation. For this reason, various alternative local and regional therapies have been used to prevent disease progression, palliate symptoms, and delay liver failure. Stereotactic body radiation therapy is a non-invasive technique of delivering ablative doses of radiation to tumors while sparing normal or non-tumor hepatic tissue. Incorporation of SBRT in multidisciplinary HCC management is gradual, initially applied when other liver-directed therapies have failed or are contraindicated, and tried in combination with other locoregional or systemic therapies for more unfavorable conditions by more experienced teams. In order to improve SBRT therapeutic ratio, there has been much interest in augmenting the effect of radiation on tumors by combining it with chemotherapy, molecularly targeted therapeutics, nanoparticles, and immunotherapy. This review aims to synthesize available evidence to evaluate the clinical feasibility and efficacy of SBRT for HCC, and to explore novel radio-potentiation concepts by combining SBRT with novel therapeutics. It is expected that those approaches would result in improved therapeutic outcomes, even though many questions remain with regard to the optimal way to assemble treatments. Further trials are needed to evaluate and consolidate these promising therapies for HCC.
Collapse
|
4
|
Han S, Lee HW, Park JY, Kim SU, Kim DY, Ahn SH, Han KH, Seong J, Won JY, Han DH, Kim BK. Appraisal of Long-Term Outcomes of Liver-Directed Concurrent Chemoradiotherapy for Hepatocellular Carcinoma with Major Portal Vein Invasion. J Hepatocell Carcinoma 2020; 7:403-412. [PMID: 33365287 PMCID: PMC7751588 DOI: 10.2147/jhc.s276528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022] Open
Abstract
Backgrounds and Aims Molecular-targeted agents are acceptable standards to treat advanced-stage hepatocellular carcinoma (HCC), however, their therapeutic benefit, ie, sorafenib, was significantly offset in case of major vessel invasion. Liver-directed concurrent chemo-radiotherapy (LD-CCRT) provided favorable outcomes in terms of survivals and tumor shrinkage, so, we appraised its long-term therapeutic efficacy. Patients and Methods Advanced HCC patients with portal vein invasion (main trunk or the 1st order branch) were enrolled. During a 5-week radiotherapy course, concurrent hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil and leucovorin was administered through an implanted port on the first and last 5 days. Four weeks after LD-CCRT, a maintenance HAIC using 5-fluorouracil and cisplatin was administered every 4 weeks. Results Among 152 patients, the objective response rates as the best response by modified Response Evaluation Criteria In Solid Tumors were 48.0% after LD-CCRT and 55.3% during subsequent HAIC maintenance. After LD-CCRT, biological responses in alpha-fetoprotein and protein induced by the absence of vitamin K or antagonist-II levels were achieved in 46.2% and 52.6%, respectively. Sixteen patients (10.5%) underwent curative resection or liver transplantation after down-staging. Median overall survival and progression-free survival were 13.5 and 6.9 months, respectively. Conclusion LD-CCRT followed by maintenance HAIC yielded favorable survival outcomes in advanced HCC patients with major portal vein invasion. Through initial tumor reduction, LD-CCRT induced down-staging with subsequent curative treatment feasible in 10.5% of patients, resulting in long-term survival. Further prospective trials are warranted to confirm these results.
Collapse
Affiliation(s)
- Sojung Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yun Won
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dai Hoon Han
- Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Liver Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
5
|
Vinorelbine Augments Radiotherapy in Hepatocellular Carcinoma. Cancers (Basel) 2020; 12:cancers12040872. [PMID: 32260169 PMCID: PMC7226273 DOI: 10.3390/cancers12040872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 12/24/2022] Open
Abstract
There is a need to improve the effectiveness of radiotherapy (RT) in hepatocellular carcinoma (HCC). Therefore, the purpose of this study was to explore the efficacy and toxicity of the anti-microtubule agent Vinorelbine as a radiosensitizer in HCC. The radio sensitivity of 16 HCC patient-derived xenograft (PDX) models was determined by quantifying the survival fraction following irradiation in vitro, and Vinorelbine radio sensitization was determined by clonogenic assay. Ectopic HCC xenografts were treated with a single dose of 8 Gy irradiation and twice-weekly 3 mg/kg Vinorelbine. Tumor growth and changes in the proteins involved in DNA repair, angiogenesis, tumor cell proliferation, and survival were assessed, and the 3/16 (18.75%), 7/16 (43.75%), and 6/16 (37.5%) HCC lines were classified as sensitive, moderately sensitive, and resistant, respectively. The combination of RT and Vinorelbine significantly inhibited tumor growth, DNA repair proteins, angiogenesis, and cell proliferation, and promoted more apoptosis compared with RT or Vinorelbine treatment alone. Vinorelbine improved HCC tumor response to standard irradiation with no increase in toxicity. HCC is prevalent in less developed parts of the world and is mostly unresectable on presentation. Vinorelbine and conventional radiotherapy are cost-effective, well-established modalities of cancer treatment that are readily available. Therefore, this strategy can potentially address an unmet clinical need, warranting further investigation in early-phase clinical trials.
Collapse
|
6
|
Efficacy and Safety of Liver-Directed Concurrent Chemoradiotherapy and Sequential Sorafenib for Advanced Hepatocellular Carcinoma: A Prospective Phase 2 Trial. Int J Radiat Oncol Biol Phys 2020; 107:106-115. [PMID: 32084526 DOI: 10.1016/j.ijrobp.2020.01.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Although sorafenib as a standard of care for advanced hepatocellular carcinoma (HCC) prolongs overall survival (OS), its efficacy is limited owing to its unsatisfactory objective response and marginal survival benefit. To counter these limitations, we designed a single-arm, phase II trial with liver-directed concurrent chemoradiotherapy (LD-CCRT) and sequential sorafenib treatment in patients with advanced HCC. METHODS AND MATERIALS We enrolled advanced HCC patients diagnosed between 2014 and 2017 who were ineligible for curative treatment. During the first and last 5 days of 5-week radiation therapy, concurrent hepatic arterial infusion with 5-fluorouracil (500 mg/d) and leucovorin (50 mg/d) through an implanted port was administered 4 weeks after initiation of LD-CCRT and sequential sorafenib treatment (400 mg, twice daily). The primary endpoint was OS. This trial has been registered at clinicaltrials.gov. RESULTS Among the enrolled patients (n = 47), objective response rates 4 weeks after LD-CCRT and during/up to sorafenib maintenance were 44.7% and 53.2%, respectively. Overall, 9 patients (19.1%) underwent curative resection or transplantation after down staging. The median radiation dose was 60 Gy. The median OS was 24.6 months for the entire cohort and 13.0 months for the subgroup with tumor invasion into the main portal trunk or its first branch, whereas the median progression-free survival for the cohort and subgroup was 6.8 and 5.6 months, respectively. The most frequent treatment-related adverse events were diarrhea (36.2%) and hand-foot skin reaction (34%), which were manageable with conservative treatment. CONCLUSIONS LD-CCRT and sequential sorafenib treatment provided favorable OS and progression-free survival with good tolerability. Tumor reduction using an initial LD-CCRT enabled down staging, subsequent curative treatment, and long-term survival in about 20% of the patients with advanced HCC. However, further randomized trials are required to confirm these results.
Collapse
|
7
|
Plasma Fibrinogen-Like 1 as a Potential Biomarker for Radiation-Induced Liver Injury. Cells 2019; 8:cells8091042. [PMID: 31489941 PMCID: PMC6770824 DOI: 10.3390/cells8091042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/15/2022] Open
Abstract
Liver damage upon exposure to ionizing radiation, whether accidental or because of therapy can contribute to liver dysfunction. Currently, radiation therapy is used for various cancers including hepatocellular carcinoma; however, the treatment dose is limited by poor liver tolerance to radiation. Furthermore, reliable biomarkers to predict liver damage and associated side-effects are unavailable. Here, we investigated fibrinogen-like 1 (FGL1)-expression in the liver and plasma after radiation exposure. We found that 30 Gy of liver irradiation (IR) induced cell death including apoptosis, necrosis, and autophagy, with fibrotic changes in the liver occurring during the acute and subacute phase in mice. Moreover, FGL1 expression pattern in the liver following IR was associated with liver damage represented by injury-related proteins and oxidative stress markers. We confirmed the association between FGL1 expression and hepatocellular injury by exposing human hepatocytes to radiation. To determine its suitability, as a potential biomarker for radiation-induced liver injury, we measured FGL1 in the liver tissue and the plasma of mice following total body irradiation (TBI) or liver IR. In TBI, FGL1 showed the highest elevation in the liver compared to other major internal organs including the heart, lung, kidney, and intestine. Notably, plasma FGL1 showed good correlation with radiation dose by liver IR. Our data revealed that FGL1 upregulation indicates hepatocellular injury in response to IR. These results suggest that plasma FGL1 may represent a potential biomarker for acute and subacute radiation exposure to the liver.
Collapse
|
8
|
Bang A, Dawson LA. Radiotherapy for HCC: Ready for prime time? JHEP Rep 2019; 1:131-137. [PMID: 32039361 PMCID: PMC7001576 DOI: 10.1016/j.jhepr.2019.05.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 12/24/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) has an evolving role in the management of hepatocellular carcinoma (HCC), largely due to recent advances in imaging technology. Often utilized in situations where other locoregional therapies are not feasible, SBRT has been demonstrated to be an effective treatment that confers high rates of durable local control. However, there is limited evidence to firmly establish its place in the treatment paradigm for HCC. In this article, we review the current evidence and highlight specific considerations in the multiple settings where SBRT may be used, including for primary HCC treatment and bridging/downstaging, as well as exploring the potential for SBRT in the treatment of extrahepatic oligo-metastatic HCC.
Collapse
Affiliation(s)
- Andrew Bang
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada, M5G 2C1
| | - Laura A Dawson
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada, M5G 2C1
| |
Collapse
|
9
|
Zhao Y, Gui W, Zhang Y, Mo G, Li D, Chong S. Inhibitory Effect of Ionizing Radiation on Echinococcus granulosus Hydatid Cyst. Diseases 2019; 7:diseases7010023. [PMID: 30781723 PMCID: PMC6473913 DOI: 10.3390/diseases7010023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/16/2019] [Accepted: 02/17/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Heavy ion radiation has more advantages than traditional radiation therapy in the treatment of cancer, mainly because of its superior biological effects. However, there is currently no reliable evidence that heavy ion radiation can induce cell death in hydatid cysts at the cellular and molecular level. In addition, we believe heavy ion therapy could be a potential alternative approach for the treatment of hydatid cysts. METHODOLOGY/PRINCIPAL FINDING The hydatid cysts and protoscolices were obtained from an experimentally infected KunMing mice. LD50 was used to evaluate the death of the protoscolex. The cellular and ultrastructure of the parasites were observed under light and electron microscopes, the damage and copy numbers of mitochondrial DNA (mtDNA) were decided by QPCR. The apoptosis was evaluated by the expression and activity of caspase3. Dose-dependent ionizing radiation induced damage to the initial mtDNA. Echinococcosis cyst after ionizing radiation showed sparse cytoplasm, disorganized and clumped organelles, huge vacuoles, and villus deletions. The kinetic of DNA repair activity after X-ray irradiation was faster than those after carbon-ion irradiation. High doses of carbon ion radiation caused irreversible attenuation of mitochondrial DNA. Cysts showed obvious reduction in size after radiation. Carbon ion radiation was more effective than X-ray radiation in inhibiting hydatid cysts. CONCLUSIONS These studies provide evidence that heavy-ion radiation can cause the extinction of hydatid cysts in vitro. The carbon-ion radiation is more advantageous than X-ray radiation in suppress hydatid cyst.
Collapse
Affiliation(s)
- Yumin Zhao
- Department of Nursing teaching and Research, School of Basic Medicine, Guilin Medical University, Guilin, Guangxi 541004, China.
| | - Weifeng Gui
- Department of Nursing teaching and Research, School of Basic Medicine, Guilin Medical University, Guilin, Guangxi 541004, China.
| | - Yishu Zhang
- Department of Nursing teaching and Research, School of Basic Medicine, Guilin Medical University, Guilin, Guangxi 541004, China.
| | - Gang Mo
- Department of Nursing teaching and Research, School of Basic Medicine, Guilin Medical University, Guilin, Guangxi 541004, China.
| | - Dayu Li
- Department of Nursing teaching and Research, School of Basic Medicine, Guilin Medical University, Guilin, Guangxi 541004, China.
| | - Shigui Chong
- Department of Nursing teaching and Research, School of Basic Medicine, Guilin Medical University, Guilin, Guangxi 541004, China.
| |
Collapse
|
10
|
Wada Y, Takami Y, Matsushima H, Tateishi M, Ryu T, Yoshitomi M, Matsumura T, Saitsu H. The Safety and Efficacy of Combination Therapy of Sorafenib and Radiotherapy for Advanced Hepatocellular Carcinoma: A Retrospective Study. Intern Med 2018; 57:1345-1353. [PMID: 29279513 PMCID: PMC5995712 DOI: 10.2169/internalmedicine.9826-17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective Sorafenib is a standard therapy for advanced hepatocellular carcinoma (HCC), whereas radiotherapy is effective for local control of extrahepatic spread (EHS) or macrovascular invasion (MVI). This study investigated the safety and efficacy of this combined therapy to treat advanced HCC. Methods This retrospective study reviewed 62 patients with advanced-stage HCC with EHS or MVI who received sorafenib therapy, excluding the patients with only lung metastases. Results Of the 62 patients, 15 were treated using the combined therapy of sorafenib and radiotherapy (group RS), and 47 were treated with sorafenib monotherapy (group S). In group RS, patients were treated using three-dimensional conformal radiotherapy with a total irradiation dose of 30-60 Gy (median, 50 Gy). Irradiation was targeted at the bone, lymph nodes, adrenal gland, and MVI in 6, 5, 1, and 4 patients, respectively. The overall incidence of adverse events was 93.3% in group RS and 91.5% in group S (p=N.S.). Incidences of thrombocytopenia, leukopenia, and skin reaction were significantly higher in group RS (73.3%, 40.0%, and 66.7%, respectively) than in group S (36.2%, 10.6%, and 27.7%, respectively, p=0.02, 0.02, and <0.01, respectively). The incidence of severe adverse events, however, was comparable in the 2 groups: 20% in group RS and 19.2% in group S. The median progression-free survival (PFS) of EHS or MVI, PFS of whole lesions, and overall survival were longer in group RS (13.5, 10.6, and 31.2 months, respectively) than in group S (3.3, 3.5, and 12.1 months, respectively) (p<0.01 for all). Conclusion Sorafenib in combination with radiotherapy is a feasible and tolerable treatment option for advanced HCC.
Collapse
Affiliation(s)
- Yoshiyuki Wada
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Yuko Takami
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Hajime Matsushima
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Masaki Tateishi
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Tomoki Ryu
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Munehiro Yoshitomi
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| | - Taisei Matsumura
- Department of Radiology, National Hospital Organization Kyushu Medical Center, Japan
| | - Hideki Saitsu
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan
| |
Collapse
|
11
|
Toesca DAS, Ibragimov B, Koong AJ, Xing L, Koong AC, Chang DT. Strategies for prediction and mitigation of radiation-induced liver toxicity. JOURNAL OF RADIATION RESEARCH 2018; 59:i40-i49. [PMID: 29432550 PMCID: PMC5868188 DOI: 10.1093/jrr/rrx104] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/12/2017] [Indexed: 05/07/2023]
Abstract
Although well described in the 1960s, liver toxicity secondary to radiation therapy, commonly known as radiation-induced liver disease (RILD), remains a major challenge. RILD encompasses two distinct clinical entities, a 'classic' form, composed of anicteric hepatomegaly, ascites and elevated alkaline phosphatase; and a 'non-classic' form, with liver transaminases elevated to more than five times the reference value, or worsening of liver metabolic function represented as an increase of 2 or more points in the Child-Pugh score classification. The risk of occurrence of RILD has historically limited the applicability of radiation for the treatment of liver malignancies. With the development of 3D conformal radiation therapy, which allowed for partial organ irradiation based on computed tomography treatment planning, there has been a resurgence of interest in the use of liver irradiation. Since then, a large body of evidence regarding the liver tolerance to conventionally fractionated radiation has been produced, but severe liver toxicities has continued to be reported. More recently, improvements in diagnostic imaging, radiation treatment planning technology and delivery systems have prompted the development of stereotactic body radiotherapy (SBRT), by which high doses of radiation can be delivered with high target accuracy and a steep dose gradient at the tumor - normal tissue interface, offering an opportunity of decreasing toxicity rates while improving tumor control. Here, we present an overview of the role SBRT has played in the management of liver tumors, addressing the challenges and opportunities to reduce the incidence of RILD, such as adaptive approaches and machine-learning-based predictive models.
Collapse
Affiliation(s)
- Diego A S Toesca
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Bulat Ibragimov
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Amanda J Koong
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| |
Collapse
|
12
|
Local Control After Stereotactic Body Radiation Therapy for Liver Tumors. Int J Radiat Oncol Biol Phys 2018; 110:188-195. [PMID: 29395629 DOI: 10.1016/j.ijrobp.2017.12.288] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/29/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To quantitatively evaluate published experiences with hepatic stereotactic body radiation therapy (SBRT), to determine local control rates after treatment of primary and metastatic liver tumors and to examine whether outcomes are affected by SBRT dosing regimen. METHODS AND MATERIALS We identified published articles that reported local control rates after SBRT for primary or metastatic liver tumors. Biologically effective doses (BEDs) were calculated for each dosing regimen using the linear-quadratic equation. We excluded series in which a wide range of BEDs was used. Individual lesion data for local control were extracted from actuarial survival curves, and data were aggregated to form a single dataset. Actuarial local control curves were generated using the Kaplan-Meier method after grouping lesions by disease type and BED (<100 Gy10 vs >100 Gy10). Comparisons were made using log-rank testing. RESULTS Thirteen articles met all inclusion criteria and formed the dataset for this analysis. The 1-, 2-, and 3-year actuarial local control rates after SBRT for primary liver tumors (n = 431) were 93%, 89%, and 86%, respectively. Lower 1- (90%), 2- (79%), and 3-year (76%) actuarial local control rates were observed for liver metastases (n = 290, log-rank P = .011). Among patients treated with SBRT for primary liver tumors, there was no evidence that local control is influenced by BED within the range of schedules used. For liver metastases, on the other hand, outcomes were significantly better for lesions treated with BEDs exceeding 100 Gy10 (3-year local control 93%) than for those treated with BEDs of ≤100 Gy10 (3-year local control 65%, P < .001). CONCLUSIONS Stereotactic body radiation therapy for primary liver tumors provides high rates of durable local control, with no clear evidence for a dose-response relationship among commonly utilized schedules. Excellent local control rates are also seen after SBRT for liver metastases when BEDs of >100 Gy10 are utilized.
Collapse
|
13
|
Zhao YT, Liu ZK, Wu QW, Dai JR, Zhang T, Jia AY, Jin J, Wang SL, Li YX, Wang WH. Observation of different tumor motion magnitude within liver and estimate of internal motion margins in postoperative patients with hepatocellular carcinoma. Cancer Manag Res 2017; 9:839-848. [PMID: 29276406 PMCID: PMC5731437 DOI: 10.2147/cmar.s147185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aims To assess motion magnitude in different parts of the liver through surgical clips in postoperative patients with hepatocellular carcinoma and to examine the correlation between the clip and diaphragm motion. Methods Four-dimensional computed tomography images from 30 liver cancer patients under thermoplastic mask immobilization were selected for this study. Three to seven surgical clips were placed in the resection cavity of each patient. The liver volume on computed tomography image was divided into the right upper (RU), right middle (RM), right lower (RL), hilar, and left lobes. Agreement between the clip and diaphragm motion was assessed by calculating intraclass correlation coefficient, and Bland–Altman analysis (Diff). Furthermore, population-based and patient-specific margins for internal motion were evaluated. Results The clips located in the RU lobe showed the largest motion, (7.5±1.6) mm, which was significantly more than in the RM lobe (5.7±2.8 mm, p=0.019), RL lobe (4.8±3.3 mm, p=0.017), and hilar lobe (4.7±2.7 mm, p<0.001) in the cranial–caudal direction. The mean intraclass correlation coefficient values between the clip and diaphragm motion were 0.915, 0.735, 0.678, 0.670, and the mean Diff values between them were 0.1±0.8 mm, 2.3±1.4 mm, 3.1±2.0 mm, 2.4±1.5 mm, when clips were located in the RU lobe, RM lobe, RL lobe, and hilar lobe, respectively. The clip and diaphragm motions had high concordance when clips were located in the RU lobe. Internal margin can be reduced from 5 mm in the cranial–caudal direction based on patient population average and to 3 mm based on patient-specific margins. Conclusions The motion magnitude of clips varied significantly depending on their location within the liver. The diaphragm was a more appropriate surrogate for tumor located in the RU lobe than for other lobes.
Collapse
Affiliation(s)
- Yu-Ting Zhao
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Kai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiu-Wen Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Jian-Rong Dai
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Zhang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Angela Y Jia
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei-Hu Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| |
Collapse
|
14
|
Leung HWC, Chan ALF. Cost-utility of stereotactic radiation therapy versus proton beam therapy for inoperable advanced hepatocellular carcinoma. Oncotarget 2017; 8:75568-75576. [PMID: 29088891 PMCID: PMC5650446 DOI: 10.18632/oncotarget.17369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/11/2017] [Indexed: 02/07/2023] Open
Abstract
The cost-utility of proton beam therapy was compared to stereotactic body radiation therapy for inoperable advanced hepatocellular carcinoma. A Markov decision-analytic model was performed following time to progression and survival using phase II trial data. Patients transitioned between three health states. Clinical outcomes were estimated for quality of life using utility estimates in the published literature and measured as incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs). Real direct medical costs were extracted from the Bureau of National Health Insurance database. One-way and probabilistic sensitivity analyses assessed the impact of specific variables on the model. In the base-case scenario, the modeled median survival was 16 months for proton beam therapy and 10 months for SBRT. Proton beam therapy resulted in an additional 2.61 quality-adjusted life years (QALYs) at an incremental cost of NT$ 557,907 compared to SBRT. The ICER was NT$ 213,354 per QALY gained. The probabilistic sensitivity analysis predicted a 97 % chance of proton beam therapy being cost-effective at the willingness to pay NT$2,157,024 per QALY gained. Thus, proton beam therapy is a cost-effective therapy for inoperable advanced hepatocellular carcinoma at the willingness-to-pay threshold of Taiwan.
Collapse
Affiliation(s)
- Henry W C Leung
- Department of Radiation Oncology, An Nan Hospital, China Medical University, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Agnes L F Chan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan.,Department of Pharmacy, An Nan Hospital, China Medical University, Tainan, Taiwan
| |
Collapse
|
15
|
Abstract
Hepatobiliary malignancies represent a heterogeneous group of diseases, which often arise in a background of underlying hepatic dysfunction complicating their local management. Surgical resection continues to be the standard of care for hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC); unfortunately the majority of patients are inoperable at presentation. The aggressiveness of these lesions makes locoregional control of particular importance. Historical experience with less sophisticated radiotherapy resulted in underwhelming efficacy and oftentimes prohibitive liver toxicity. However, with the advent of extremely conformal and precise radiotherapy delivery, dose escalation to the tumor with sparing of surrounding normal tissue has yielded notable improvements in efficacy for this modality of treatment. Dose escalation has come in a variety of forms most notably as stereotactic body radiation therapy (SBRT) and hypofractionated proton therapy. As radiation techniques continue to improve, their proper incorporation into the local management of hepatobiliary malignancies will be paramount in improving the prognosis of what is a grave diagnosis.
Collapse
Affiliation(s)
- Jonathan W Lischalk
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Michael C Repka
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Keith Unger
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
16
|
Exploration of Superior Modality: Safety and Efficacy of Hypofractioned Image-Guided Intensity Modulated Radiation Therapy in Patients with Unresectable but Confined Intrahepatic Hepatocellular Carcinoma. Can J Gastroenterol Hepatol 2017; 2017:6267981. [PMID: 29098144 PMCID: PMC5643031 DOI: 10.1155/2017/6267981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/10/2017] [Accepted: 09/17/2017] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of hypofractioned image-guided intensity modulated radiation therapy (IG-IMRT) for unresectable but confined intrahepatic hepatocellular carcinoma in comparison with conventional 3-dimensional conformal radiotherapy (3D-CRT). METHODS Ninety patients with unresectable but confined intrahepatic hepatocellular carcinoma without distant metastasis and tumor thrombosis received external beam radiation therapy. Of these patients, 45 received IG-IMRT and 45 received 3D-CRT. The IG-IMRT design delivered a median total hypofractionated dose of 54 Gy (2.2-5.5 Gy/fx), and 3D-CRT delivered a median total dose of 54 Gy with a conventional fraction (2.0 Gy/fx). The clinical response, overall survival, and side effects were analyzed. RESULTS The IG-IMRT group showed significantly higher 1-year survival (93.3 versus 77.8%) and 2-year survival (73.3 versus 51.1%) and longer median survival (44.7 versus 24.0 months) than the 3D-CRT group. Multivariate analysis indicated that the patients with intrahepatic tumors smaller than 8 cm, prior TACE before RT, and IG-IMRT would have a survival benefit. There were no significant differences in the rates of side effects between the two groups. CONCLUSION Hypofractioned IG-IMRT could improve the therapeutic response and confer a potential survival of patients with unresectable but confined intrahepatic hepatocellular carcinoma compared to 3D-CRT with acceptable toxicity.
Collapse
|
17
|
Ohri N, Dawson LA, Krishnan S, Seong J, Cheng JC, Sarin SK, Kinkhabwala M, Ahmed MM, Vikram B, Coleman CN, Guha C. Radiotherapy for Hepatocellular Carcinoma: New Indications and Directions for Future Study. J Natl Cancer Inst 2016; 108:djw133. [PMID: 27377923 DOI: 10.1093/jnci/djw133] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 04/18/2016] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer death worldwide; its incidence is increasing in the United States. Depending on disease extent and underlying liver status, patients may be treated with local, locoregional, and/or systemic therapy. Recent data indicates that radiotherapy (RT) can play a meaningful role in the management of HCC. Here, we review published experiences using RT for HCC, including the use of radiosensitizers and stereotactic RT. We discuss methods for performing preclinical studies of RT for HCC and biomarkers of response. As a part of the HCC Working Group, an informal committee of the National Cancer Institute's Radiation Research Program, we suggest how RT should be implemented in the management of HCC and identify future directions for the study of RT in HCC.
Collapse
Affiliation(s)
- Nitin Ohri
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Laura A Dawson
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sunil Krishnan
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jinsil Seong
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jason C Cheng
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Shiv K Sarin
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Milan Kinkhabwala
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mansoor M Ahmed
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bhadrasain Vikram
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - C Norman Coleman
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Chandan Guha
- Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD.
| |
Collapse
|
18
|
Zhang T, Zhao YT, Wang Z, Li CR, Jin J, Jia AY, Wang SL, Song YW, Liu YP, Ren H, Fang H, Bao H, Liu XF, Yu ZH, Li YX, Wang WH. Efficacy and Safety of Intensity-Modulated Radiotherapy Following Transarterial Chemoembolization in Patients With Unresectable Hepatocellular Carcinoma. Medicine (Baltimore) 2016; 95:e3789. [PMID: 27227954 PMCID: PMC4902378 DOI: 10.1097/md.0000000000003789] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Three-dimensional conformal radiotherapy in combination with transarterial chemoembolization (TACE) has been beneficial in patients with unresectable hepatocellular carcinoma (HCC). There have been few clinical reports on the use of intensity-modulated radiotherapy (IMRT) in combination with TACE for these patients. The purpose of this study was to assess the efficacy and toxicity of IMRT following TACE in unresectable HCC.The medical records of consecutive patients with unresectable HCC, who underwent IMRT following TACE from January 2009 to June 2014, were retrospectively reviewed in order to assess the overall survival (OS), progression-free survival (PFS), tumor response, and treatment-associated toxicity.A total of 64 lesions in 54 patients were included in the analysis. IMRT was delivered at a median dose of 50 Gy (range 44-70 Gy) at 1.8 to 2.0 Gy per fraction. The overall response rate was achieved in 64.8% of patients with complete response in 20.4% of patients at 3 months after completion of IMRT. The median OS was 20.2 months (95% CI = 8.6-31.9), and the actuarial 1-, 2-, and 3-year OS rates were 84.6%, 49.7%, and 36.7%, respectively. The median PFS was 10.5 months (95% CI = 7.3-13.7) and the 1-, 2-, and 3-year PFS rates were 44.2%, 23.4%, and 14.6%, respectively. The responders had a significantly higher OS rate than the nonresponders (3-year OS 48.0% vs 14.4%, P = 0.001). During and the first month following IMRT, 10 (18.5%) patients developed grade 3 hematological toxicity, and 3 (5.6%) developed grade 3 hepatic toxicity. No patient experienced grade 4 or 5 toxicity. Radiation-induced liver disease was not observed.Our findings suggest that IMRT following TACE could be a favorable treatment option for both its safety profile and clinical benefit in patients with unresectable HCC.
Collapse
Affiliation(s)
- Tao Zhang
- From the Departments of Radiation Oncology (TZ, Y-TZ, ZW, JJ, S-LW, Y-WS, Y-PL, HR, HF, X-FL, Z-HY, Y-XL, W-HW), Interventional Radiology (C-RL), Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China; Department of Medicine (AYJ), Weill Cornell Medical College, New York City, NY; and Department of Oncology (HB), Yan'an University Affiliated Hospital, Yan'an Shaanxi Province, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Yoon HI, Song KJ, Lee IJ, Kim DY, Han KH, Seong J. Clinical Benefit of Hepatic Arterial Infusion Concurrent Chemoradiotherapy in Locally Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis. Cancer Res Treat 2016; 48:190-7. [PMID: 25761480 PMCID: PMC4720094 DOI: 10.4143/crt.2014.276] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/18/2014] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate whether hepatic arterial infusion concurrent chemoradiotherapy (CCRT) could improve overall survival (OS) in patients with locally advanced hepatocellular carcinoma (LAHCC). MATERIALS AND METHODS Two databases were reviewed from Yonsei Cancer Center (YCC) and Korean Liver Cancer Study Group (KLCSG) nationwide multi-center hepatocellular carcinoma (HCC) cohort. The CCRT group included 106 patients, with stage III-IV, Child-Pugh classification A, Eastern Cooperative Oncology Group performance status 0 or 1, who underwent definitive CCRT as the initial treatment at YCC. We used propensity score matching to adjust for seven clinical factors, including age, tumor size, TNM stage by the Liver Cancer Study Group of Japan, T stage, Barcelona Clinic Liver Cancer (BCLC) staging system, etiology of HCC, and portal vein invasion, which all differed significantly in the two databases. From the KLCSG cohort enrolled at 32 institutions, 106 patients for the non-CCRT group were defined. RESULTS After propensity score matching, all patient characteristics were balanced between the two groups. The CCRT group had better OS (median, 11.4) than the non-CCRT group (6.6 months, p=0.02). In multivariate analyses for all patients, CCRT (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.11 to 1.97; p=0.007), tumor size (HR, 1.08; 95% CI, 1.04 to 1.12; p < 0.001), and BCLC stage (HR, 0.54; 95% CI, 0.36 to 0.8; p=0.003) were independent prognostic factors for OS. CONCLUSION CCRT showed better OS for LAHCC patients. In LAHCC patients with a good performance and normal liver function, CCRT could be a feasible treatment option. All of these findings need to be validated in prospective clinical trials.
Collapse
Affiliation(s)
- Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- Department of Pharmacology, Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jun Song
- Department of Biostatics, Yonsei University College of Medicine, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
- Korean Liver Cancer Study Group, Seoul, Korea
| | - Do Young Kim
- Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
- Korean Liver Cancer Study Group, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
- Korean Liver Cancer Study Group, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
- Korean Liver Cancer Study Group, Seoul, Korea
| |
Collapse
|
20
|
Yeh SA, Chen YS, Perng DS. The role of radiotherapy in the treatment of hepatocellular carcinoma with portal vein tumor thrombus. JOURNAL OF RADIATION RESEARCH 2015; 56:325-31. [PMID: 25411553 PMCID: PMC4380051 DOI: 10.1093/jrr/rru104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The aim of this study was to evaluate the role of radiotherapy in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVT) and to determine the prognostic factors for overall survival. Altogether, 106 patients with HCC and PVT referred for radiotherapy between 2004 and 2009 were retrospectively reviewed. A total of 60 Gy in 30 daily fractions was delivered with intensity-modulated radiotherapy techniques. Patient-related and treatment-related factors were analyzed to evaluate their prognostic significance for the overall survival rate. Complete response was noted in 10 patients and partial response in 55 patients. The liver lesions had become resectable after the completion of radiotherapy in 12 patients, and surgery was subsequently performed. One or two courses of transarterial chemoembolization (TACE) were administered to 19 patients following radiotherapy. The 1-year and 2-year overall survival rates were 34.7% and 11%, respectively, and the median survival was 7 months for the entire cohort of patients. Post-radiotherapy treatment modality, response to radiotherapy and JIS score were demonstrated as independent prognostic factors for overall survival (P = 0.003, P < 0.001, P < 0.001, respectively). For patients who received surgical intervention after radiotherapy, the median survival was 30 months and the 2-year overall survival rate was 67%. Radiotherapy achieved a 61.5% objective response rate and prolonged survival in patients with PVT. The liver tumors had become resectable after radiotherapy in 11% of patients. Our results suggested that radiotherapy could offer survival benefits and should be considered as a treatment option for patients with PVT. Radiotherapy could also be considered as a preoperative treatment modality in patients with HCC and PVT.
Collapse
Affiliation(s)
- Shyh-An Yeh
- Department of Radiation Oncology, E-DA Hospital, Kaohsiung City, Taiwan Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung City, Taiwan
| | - Yaw-Sen Chen
- Department of General Surgery, E-DA Hospital, Kaohsiung City, Taiwan
| | - Daw-Shyong Perng
- Department of Gastroenterology, E-DA Hospital, Kaohsiung City, Taiwan
| |
Collapse
|
21
|
Lo SS, Cardenes HR, Teh BS, Fakiris AJ, Henderson MA, Papiez L, McGarry RC, Wang JZ, Li K, Mayr NA, Timmerman RD. Stereotactic body radiation therapy for nonpulmonary primary tumors. Expert Rev Anticancer Ther 2014; 8:1939-51. [DOI: 10.1586/14737140.8.12.1939] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
22
|
Zhou X, Zhao Y, Zhou R, Zhang H. Suppression of E. multilocularis hydatid cysts after ionizing radiation exposure. PLoS Negl Trop Dis 2013; 7:e2518. [PMID: 24205427 PMCID: PMC3812096 DOI: 10.1371/journal.pntd.0002518] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/19/2013] [Indexed: 11/19/2022] Open
Abstract
Background Heavy-ion therapy has an advantage over conventional radiotherapy due to its superb biological effectiveness and dose conformity in cancer therapy. It could be a potential alternate approach for hydatid cyst treatment. However, there is no information currently available on the cellular and molecular basis for heavy-ion irradiation induced cell death in cystic echinococcosis. Methododology/Principal Findings LD50 was scored by protoscolex death. Cellular and ultrastructural changes within the parasite were studied by light and electron microscopy, mitochondrial DNA (mtDNA) damage and copy number were measured by QPCR, and apoptosis was determined by caspase 3 expression and caspase 3 activity. Ionizing radiation induced sparse cytoplasm, disorganized and clumped organelles, large vacuoles and devoid of villi. The initial mtDNA damage caused by ionizing radiation increased in a dose-dependent manner. The kinetic of DNA repair was slower after carbon-ion radiation than that after X-rays radiation. High dose carbon-ion radiation caused irreversible mtDNA degradation. Cysts apoptosis was pronounced after radiation. Carbon-ion radiation was more effective to suppress hydatid cysts than X-rays. Conclusions These studies provide a framework to the evaluation of attenuation effect of heavy-ion radiation on cystic echinococcosis in vitro. Carbon-ion radiation is more effective to suppress E. multilocularis than X-rays. Surgical removal of cysts may be impractical in cases that cysts are in multiple organs or tissues, or in risky locations. In that case, alternative treatment should be employed. Heavy-ion radiation could be an effective way for treatment of hydatid cysts, taking its full advantage of well-defined range, small lateral beam spread and an enhanced biological effectiveness. In this study, we found that carbon-ion radiation could result in extensive mitochondrial DNA damage and apoptosis in hydatid cysts. Cellular and ultrastructural changes were observed after ionizing radiation, which were indicative of cysts growth inhibition. To our knowledge, this is the first study reporting the biological effect of carbon-ion radiation on E. multilocularis hydatid cysts.
Collapse
Affiliation(s)
- Xin Zhou
- Department of Heavy Ion Radiation Medicine, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Heavy Ion Radiation Medicine of Gansu Province, Lanzhou, China
| | - Yumin Zhao
- Department of Parasitology, Guilin Medical University, Guilin, Guangxi, China
| | - Rong Zhou
- Department of Heavy Ion Radiation Medicine, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Heavy Ion Radiation Medicine of Gansu Province, Lanzhou, China
| | - Hong Zhang
- Department of Heavy Ion Radiation Medicine, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Heavy Ion Radiation Medicine of Gansu Province, Lanzhou, China
- * E-mail:
| |
Collapse
|
23
|
Cha J, Seong J, Lee IJ, Kim JW, Han KH. Feasibility of sorafenib combined with local radiotherapy in advanced hepatocellular carcinoma. Yonsei Med J 2013; 54:1178-85. [PMID: 23918567 PMCID: PMC3743177 DOI: 10.3349/ymj.2013.54.5.1178] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Sorafenib is an effective systemic agent for advanced hepatocellular carcinoma. To increase its efficacy, we evaluated the feasibility and benefit of sorafenib combined with radiotherapy. MATERIALS AND METHODS From July 2007 to July 2011, 31 patients were treated with a daily dose of 800 mg of sorafenib and radiotherapy. Among them, 13 patients who received radiotherapy on the bone metastasis were excluded. Thirteen patients received 30-54 Gy of radiotherapy on the primary tumor (primary group) and 5 patients received 30-58.4 Gy on the measurable metastatic lesions (measurable metastasis group). Tumor responses at 1 month after the completion of radiotherapy and overall survival were evaluated. RESULTS The in-field response rate was 100% in the primary group and 60% in the measurable metastasis group. A decrease of more than 80% in the tumor marker α-fetoprotein was observed in 7 patients in the primary group (54%). Toxicities of grades 3-4 were hand-foot syndrome in 3 (17%) patients, duodenal bleeding in 1 (6%) patient, thrombocytopenia in 3 (17%) patients and elevation of aspartate transaminase in 1 (6%) patient. The median overall survival was 7.8 months (95% confidence interval, 3.0-12.6). CONCLUSION The combined treatment of sorafenib and radiotherapy was feasible and induced substantial tumor responses in the target lesions. The results of this study emphasize the importance of individualized approach in the management of advanced hepatocellular carcinoma and encourage the initiation of a controlled clinical trial.
Collapse
Affiliation(s)
- Jihye Cha
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Cancer Special Clinic, Yonsei University Health System, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Yonsei Liver Cancer Special Clinic, Yonsei University Health System, Seoul, Korea
| |
Collapse
|
24
|
Ogino R, Hosono M, Ishii K, Tatsumi D, Tsutsumi S, Miki Y, Masuoka Y, Shimatani Y, Miki Y. A dose-volume intercomparison of volumetric-modulated arc therapy, 3D static conformal, and rotational conformal techniques for portal vein tumor thrombus in hepatocellular carcinoma. JOURNAL OF RADIATION RESEARCH 2013; 54:697-705. [PMID: 23418389 PMCID: PMC3709667 DOI: 10.1093/jrr/rrs139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 12/16/2012] [Accepted: 12/24/2012] [Indexed: 06/01/2023]
Abstract
We created volumetric-modulated arc therapy (VMAT) plans for portal vein tumor thrombus (PVTT) in hepatocellular carcinoma, and compared the results with those from three-dimensional conformal radiotherapy (3D-CRT) and rotational conformal radiotherapy (R-CRT) plans. CT scan data from 10 consecutive patients with PVTT treated with 3D-CRT between January 2008 and January 2010 were utilized in the analysis. We analyzed the dosimetric properties of the plans for the 10 patients using the three different techniques with three different isocenter doses of 50, 56 and 60 Gy in 2-Gy fractions. The D95, Dmean, homogeneity index and conformity index were compared for the planning target volume (PTV). The Dmean, V20 and V30 were also compared for normal livers. The monitor units (MUs) and the treatment time were also evaluated. The normal liver V30 for VMAT was significantly less than that for 3D-CRT for the prescribed doses of 56 and 60 Gy (P < 0.05). It was also found that the normal liver V30 resulting from 3D-CRT was prohibitively increased when the prescribed dose was increased in two steps. For PTV D95, we found no significant differences between the three techniques for the 50- and 56-Gy prescriptions, or between VMAT and the other techniques for the 60-Gy prescription. The differences in the MUs and treatment times were not statistically significant between VMAT and 3D-CRT. We have demonstrated that VMAT may be a more advantageous technique for dose escalation reaching 60 Gy in the treatment of PVTT due to the reduced normal liver V30.
Collapse
Affiliation(s)
- Ryo Ogino
- Department of Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
|
26
|
|
27
|
Massabeau C, Marchand V, Zefkili S, Servois V, Campana F, Giraud P. Early experience of helical tomotherapy for hepatobiliary radiotherapy. Case Reports Hepatol 2011; 2011:545267. [PMID: 25954545 PMCID: PMC4411892 DOI: 10.1155/2011/545267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 05/14/2011] [Indexed: 11/17/2022] Open
Abstract
Helical tomotherapy (HT), an image-guided, intensity-modulated, radiation therapy technique, allows for precise targeting while sparing normal tissues. We retrospectively assessed the feasibility and tolerance of the hepatobiliary HT in 9 patients. A total dose of 54 to 60 Gy was prescribed (1.8 or 2 Gy per fraction) with concurrent capecitabine for 7 patients. There were 1 hepatocarcinoma, 3 cholangiocarcinoma, 4 liver metastatic patients, and 1 pancreatic adenocarcinoma. All but one patient received previous therapies (chemotherapy, liver radiofrequency, and/or surgery). The median doses delivered to the normal liver and to the right kidney were 15.7 Gy and 4.4 Gy, respectively, below the recommended limits for all patients. Most of the treatment-related adverse events were transient and mild in severity. With a median followup of 12 months, no significant late toxicity was noted. Our results suggested that HT could be safely incorporated into the multidisciplinary treatment of hepatobiliary or pancreatic malignant disease.
Collapse
Affiliation(s)
- Carole Massabeau
- Department of Radiation Oncology and Medical Physics, Institut Curie, 75005 Paris, France
- Department of Radiation Oncology, Institut Claudius Regaud, 31052 Toulouse, France
| | - Virginie Marchand
- Department of Radiation Oncology and Medical Physics, Institut Curie, 75005 Paris, France
| | - Sofia Zefkili
- Department of Radiation Oncology and Medical Physics, Institut Curie, 75005 Paris, France
| | - Vincent Servois
- Department of Radiology, Institut Curie, 75005 Paris, France
| | - François Campana
- Department of Radiation Oncology and Medical Physics, Institut Curie, 75005 Paris, France
| | - Philippe Giraud
- Department of Radiation Oncology and Medical Physics, Institut Curie, 75005 Paris, France
- Department of Radiation Oncology, European Georges Pompidou Hospital, 75015 Paris, Paris Descartes University, 75005 Paris, France
| |
Collapse
|
28
|
Kuo YC, Chiu YM, Shih WP, Yu HW, Chen CW, Wong PF, Lin WC, Hwang JJ. Volumetric intensity-modulated Arc (RapidArc) therapy for primary hepatocellular carcinoma: comparison with intensity-modulated radiotherapy and 3-D conformal radiotherapy. Radiat Oncol 2011; 6:76. [PMID: 21693003 PMCID: PMC3138395 DOI: 10.1186/1748-717x-6-76] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 06/21/2011] [Indexed: 12/23/2022] Open
Abstract
Background To compare the RapidArc plan for primary hepatocellular carcinoma (HCC) with 3-D conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) plans using dosimetric analysis. Methods Nine patients with unresectable HCC were enrolled in this study. Dosimetric values for RapidArc, IMRT, and 3DCRT were calculated for total doses of 45~50.4 Gy using 1.8 Gy/day. The parameters included the conformal index (CI), homogeneity index (HI), and hot spot (V107%) for the planned target volume (PTV) as well as the monitor units (MUs) for plan efficiency, the mean dose (Dmean) for the organs at risk (OAR) and the maximal dose at 1% volume (D1%) for the spinal cord. The percentage of the normal liver volume receiving ≥ 40, > 30, > 20, and > 10 Gy (V40 Gy, V30 Gy, V20 Gy, and V10 Gy) and the normal tissue complication probability (NTCP) were also evaluated to determine liver toxicity. Results All three methods achieved comparable homogeneity for the PTV. RapidArc achieved significantly better CI and V107% values than IMRT or 3DCRT (p < 0.05). The MUs were significantly lower for RapidArc (323.8 ± 60.7) and 3DCRT (322.3 ± 28.6) than for IMRT (1165.4 ± 170.7) (p < 0.001). IMRT achieved a significantly lower Dmean of the normal liver than did 3DCRT or RapidArc (p = 0.001). 3DCRT had higher V40 Gy and V30 Gy values for the normal liver than did RapidArc or IMRT. Although the V10 Gy to the normal liver was higher with RapidArc (75.8 ± 13.1%) than with 3DCRT or IMRT (60.5 ± 10.2% and 57.2 ± 10.0%, respectively; p < 0.01), the NTCP did not differ significantly between RapidArc (4.38 ± 2.69) and IMRT (3.98 ± 3.00) and both were better than 3DCRT (7.57 ± 4.36) (p = 0.02). Conclusions RapidArc provided favorable tumor coverage compared with IMRT or 3DCRT, but RapidArc is not superior to IMRT in terms of liver protection. Further studies are needed to establish treatment outcome differences between the three approaches.
Collapse
Affiliation(s)
- Yu-Cheng Kuo
- Dept, of Biomedical Imaging & Radiological Sciences, National Yang-Ming University, Taipei 11221, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Radiothérapie externe des carcinomes hépatocellulaires. Cancer Radiother 2011; 15:49-53. [DOI: 10.1016/j.canrad.2010.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 10/12/2010] [Indexed: 12/27/2022]
|
30
|
Yeo SG, Kim DY, Kim TH, Kim SY, Hong YS, Jung KH. Whole-liver radiotherapy for end-stage colorectal cancer patients with massive liver metastases and advanced hepatic dysfunction. Radiat Oncol 2010; 5:97. [PMID: 20977728 PMCID: PMC2987942 DOI: 10.1186/1748-717x-5-97] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 10/26/2010] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To investigate whether whole-liver radiotherapy (RT) is beneficial in end-stage colorectal cancer with massive liver metastases and severe hepatic dysfunction. METHODS Between June 2004 and July 2008, 10 colorectal cancer patients, who exhibited a replacement of over three quarters of their normal liver by metastatic tumors and were of Child-Pugh class B or C in liver function with progressive disease after undergoing chemotherapy, underwent whole-liver RT. RT was administered using computed tomography-based three-dimensional planning and the median dose was 21 Gy (range, 21-30) in seven fractions. Improvement in liver function tests, defined as a decrease in the levels within 1 month after RT, symptom palliation, toxicity, and overall survival were analyzed retrospectively. RESULTS Levels of alkaline phosphatase, total bilirubin, aspartate transaminase, and alanine transaminase improved in 8, 6, 9, and all 10 patients, respectively, and the median reduction rates were 42%, 68%, 50%, and 57%, respectively. Serum carcinoembryonic antigen level decreased after RT in three of four assessable patients. For all patients, pain levels decreased and acute toxicity consisted of nausea/vomiting of grade ≤ 2. Further chemotherapy became possible in four of 10 patients. Mean survival after RT was 80 ± 80 days (range, 20-289); mean survival for four patients who received post-RT chemotherapy was 143 ± 100 days (range, 65-289), versus 38 ± 16 days (range, 20-64) for the six patients who did not receive post-RT chemotherapy (p = 0.127). CONCLUSIONS Although limited by small case number, this study demonstrated a possible role of whole-liver RT in improving hepatic dysfunction and delaying mortality from hepatic failure for end-stage colorectal cancer patients with massive liver metastases. Further studies should be followed to confirm these findings.
Collapse
Affiliation(s)
- Seung-Gu Yeo
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | | | | | | | | | | |
Collapse
|
31
|
Phase I feasibility trial of stereotactic body radiation therapy for primary hepatocellular carcinoma. Clin Transl Oncol 2010; 12:218-25. [PMID: 20231127 DOI: 10.1007/s12094-010-0492-x] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is increasing in incidence and the majority of patients are not candidates for radical therapies. Therefore, interest in minimally invasive therapies in growing. METHODS A Phase I dose escalation trial was conducted at Indiana University to determine the feasibility and toxicity of stereotactic body radiation therapy (SBRT) for primary HCC. Eligible patients had Child-Turcotte-Pugh's Class (CTP) A or B, were not candidates for resection, had 1-3 lesions and cumulative tumour diameter less than or equal to 6 cm. Dose escalation started at 36 Gy in 3 fractions (12 Gy/fraction) with a subsequent planned escalation of 2 Gy/ fraction/level. Dose-limiting toxicity (DLT) was defined as Common Terminology Criteria for Adverse Events v3.0 grade 3 or greater toxicity. RESULTS Seventeen patients with 25 lesions were enrolled. Dose was escalated to 48 Gy (16 Gy/fraction) in CTP-A patients without DLT. Two patients with CPC-B disease developed grade 3 hepatic toxicity at the 42-Gy (14 Gy/fraction) level. The protocol was amended for subsequent CTP-B patients to receive a regimen of 5 fractions starting at 40 Gy (8 Gy/fraction) with one patient experiencing progressive liver failure. Four additional patients were enrolled (one died of unrelated causes after an incomplete SBRT course) without DLT. The only factor related to more than one grade 3 or greater liver toxicity or death within 6 months was the CTP score (p=0.03). Six patients underwent a liver transplant. Ten patients are alive without progression with a median FU of 24 months (10-42 months), with local control/stabilisation of the disease of 100%. One and two-year Kaplan-Meier estimates for overall survival are 75% and 60%, respectively. CONCLUSIONS SBRT is a non-invasive feasible and well tolerated therapy in adequately selected patients with HCC. The preliminary local control and survival are encouraging. A confirmatory Phase II trial is currently open to accrual.
Collapse
|
32
|
Imada H, Kato H, Yasuda S, Yamada S, Yanagi T, Kishimoto R, Kandatsu S, Mizoe JE, Kamada T, Yokosuka O, Tsujii H. Comparison of efficacy and toxicity of short-course carbon ion radiotherapy for hepatocellular carcinoma depending on their proximity to the porta hepatis. Radiother Oncol 2010; 96:231-5. [PMID: 20579756 DOI: 10.1016/j.radonc.2010.05.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 03/04/2010] [Accepted: 05/21/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE To compare the efficacy and toxicity of short-course carbon ion radiotherapy (C-ion RT) for patients with hepatocellular carcinoma (HCC) in terms of tumor location: adjacent to the porta hepatis or not. MATERIALS AND METHODS The study consisted of 64 patients undergoing C-ion RT of 52.8 GyE in four fractions between April 2000 and March 2003. Of these patients, 18 had HCC located within 2 cm of the main portal vein (porta hepatis group) and 46 patients had HCC far from the porta hepatis (non-porta hepatis group). We compared local control, survival, and adverse events between the two groups. RESULTS The 5-year overall survival and local control rates were 22.2% and 87.8% in the porta hepatis group and 34.8% and 95.7% in the non-porta hepatis group, respectively. There were no significant differences (P=0.252, P=0.306, respectively). Further, there were no significant differences in toxicities. Biliary stricture associated with C-ion RT did not occur. CONCLUSIONS Excellent local control was obtained independent of tumor location. The short-course C-ion RT of 52.8 GyE in four fractions appears to be an effective and safe treatment modality in the porta hepatis group just as in the non-porta hepatis group.
Collapse
Affiliation(s)
- Hiroshi Imada
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Hsieh CH, Liu CY, Shueng PW, Chong NS, Chen CJ, Chen MJ, Lin CC, Wang TE, Lin SC, Tai HC, Tien HJ, Chen KH, Wang LY, Hsieh YP, Huang DYC, Chen YJ. Comparison of coplanar and noncoplanar intensity-modulated radiation therapy and helical tomotherapy for hepatocellular carcinoma. Radiat Oncol 2010; 5:40. [PMID: 20492727 PMCID: PMC2881007 DOI: 10.1186/1748-717x-5-40] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 05/23/2010] [Indexed: 12/24/2022] Open
Abstract
Background To compare the differences in dose-volume data among coplanar intensity modulated radiotherapy (IMRT), noncoplanar IMRT, and helical tomotherapy (HT) among patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT). Methods Nine patients with unresectable HCC and PVT underwent step and shoot coplanar IMRT with intent to deliver 46 - 54 Gy to the tumor and portal vein. The volume of liver received 30Gy was set to keep less than 30% of whole normal liver (V30 < 30%). The mean dose to at least one side of kidney was kept below 23 Gy, and 50 Gy as for stomach. The maximum dose was kept below 47 Gy for spinal cord. Several parameters including mean hepatic dose, percent volume of normal liver with radiation dose at X Gy (Vx), uniformity index, conformal index, and doses to organs at risk were evaluated from the dose-volume histogram. Results HT provided better uniformity for the planning-target volume dose coverage than both IMRT techniques. The noncoplanar IMRT technique reduces the V10 to normal liver with a statistically significant level as compared to HT. The constraints for the liver in the V30 for coplanar IMRT vs. noncoplanar IMRT vs. HT could be reconsidered as 21% vs. 17% vs. 17%, respectively. When delivering 50 Gy and 60-66 Gy to the tumor bed, the constraints of mean dose to the normal liver could be less than 20 Gy and 25 Gy, respectively. Conclusion Noncoplanar IMRT and HT are potential techniques of radiation therapy for HCC patients with PVT. Constraints for the liver in IMRT and HT could be stricter than for 3DCRT.
Collapse
Affiliation(s)
- Chen-Hsi Hsieh
- Department of Radiation Oncology, Mackay Memorial Hospital, and Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Imada H, Kato H, Yasuda S, Yamada S, Yanagi T, Hara R, Kishimoto R, Kandatsu S, Minohara S, Mizoe JE, Kamada T, Yokosuka O, Tsujii H. Compensatory enlargement of the liver after treatment of hepatocellular carcinoma with carbon ion radiotherapy - relation to prognosis and liver function. Radiother Oncol 2010; 96:236-42. [PMID: 20416964 DOI: 10.1016/j.radonc.2010.03.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 12/03/2009] [Accepted: 03/18/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE To examine whether liver volume changes affect prognosis and hepatic function in patients treated with carbon ion radiotherapy (CIRT) for hepatocellular carcinoma (HCC). MATERIAL AND METHODS Between April 1995 and March 2003, among the cases treated with CIRT, 43 patients with HCC limited to the right hepatic lobe were considered eligible for the study. The left lateral segment was defined as the non-irradiated region. Liver volume was measured using contrast CT at 0, 3, 6, and 12 months after CIRT. We examined serum albumin, prothrombin activity, and total bilirubin level as hepatic functional reserve. RESULTS After CIRT, the non-irradiated region showed significant enlargement, and enlarged volume of this region 3 months after CIRT 50 cm(3) was a prognostic factor. The 5-year overall survival rates were 48.9% in the larger enlargement group (enlarged volume of non-irradiated region 3 months after CIRT > or =50 cm(3)) and 29.4% in the smaller enlargement group (as above, <50 cm(3)). The larger enlargement group showed better hepatic functional reserve than the smaller enlargement group 12 months after CIRT. CONCLUSIONS This study suggests that compensatory enlargement in the non-irradiated liver after CIRT contributes to the improvement of prognosis.
Collapse
Affiliation(s)
- Hiroshi Imada
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Inage-ku, Chiba, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Yttrium-90 radioembolization in the management of liver tumors: expanding the global experience. Eur J Nucl Med Mol Imaging 2009; 37:451-2. [DOI: 10.1007/s00259-009-1345-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
36
|
Abstract
Hepatocellular carcinoma (HCC) is one of the most critical global health issues. With frequent association of viral liver disease, HCC is highly complex, harboring both cancer and chronic liver disease. The tumor stage and underlying liver function are both major determinants of the treatment selection as well as prognosis in HCC patients, thus allowing no more than a 20% chance for potentially curative therapies. Radiotherapy technology has been evolved remarkably during the past decade, and radiation can be precisely delivered, thereby permitting higher doses to the tumour and reduced doses to surrounding normal tissues. There has been increasing interest in the merits of radiotherapy in HCC over the past few years, as indicated by a Pub Med search. Radiotherapy has been used as the definitive therapy with curative intent in early stage tumours. It has been used also in combination with TACE for intermediate stage tumours. In locally advanced tumours, radiotherapy has been combined with systemic agents. Despite its efficacy, radiotherapy has not yet been incorporated into the standard management guidelines of HCC. The lack of high evidence level data, especially randomized controlled trials, has posed an obstacle in including radiotherapy into the routine treatment schema of HCC. Therefore, well-designed prospective studies are strongly recommended using developing technology for radiotherapy alone or combination therapies. Also, many issues such as the optimal dose-fractionation, intra- or extrahepatic metastasis after radiotherapy, and radiation-induced hepatic dysfunction remain to be solved. In this review, current status of radiotherapy for HCC will be discussed with regard to technical consideration and combination strategy. The limitation and future perspectives will also be discussed.
Collapse
Affiliation(s)
- Jinsil Seong
- Department of Radiation Oncology, Yonsei Liver Cancer Special Clinic, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
37
|
Jang JW, Kay CS, You CR, Kim CW, Bae SH, Choi JY, Yoon SK, Han CW, Jung HS, Choi IB. Simultaneous Multitarget Irradiation Using Helical Tomotherapy for Advanced Hepatocellular Carcinoma With Multiple Extrahepatic Metastases. Int J Radiat Oncol Biol Phys 2009; 74:412-8. [PMID: 18963538 DOI: 10.1016/j.ijrobp.2008.08.034] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 08/05/2008] [Indexed: 01/14/2023]
|
38
|
Cárdenes HR. Role of stereotactic body radiotherapy in the management of primary hepatocellular carcinoma. Rationale, technique and results. Clin Transl Oncol 2009; 11:276-83. [DOI: 10.1007/s12094-009-0355-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
39
|
Reardon KA, McIntosh AF, Shilling AT, Hagspiel KD, Al-Osaimi A, Berg C, Caldwell SH, Northup PG, Angle F, Mulder R, Rich TA. Treatment of Primary Liver Tumors with Yttrium-90 Microspheres (TheraSphere®) in High Risk Patients: Analysis of Survival and Toxicities. Technol Cancer Res Treat 2009; 8:71-7. [DOI: 10.1177/153303460900800109] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This retrospective study was undertaken to obtain information regarding the survival and toxicities after Yttrium-90 microspheres treatment in patients with primary liver malignancies. Baseline, treatment, and follow-up data were collected and analyzed for 21 patients treated with Yttrium-90 microspheres. Survival analysis was then performed. The results of this study showed that median survival for all the patients was 120 days. Twenty of 21 patients were categorized as high-risk with a median survival of 114 days. It was also found that one high-risk patient has survived 858 days with no recurrence of disease. Acute grade 3–5 toxicities were recorded for nine patients and consisted of elevations in AST and bilirubin, thrombocytopenia, abdominal pain, ascites, nausea, fatigue, and death. This study concluded that Yttrium-90 is a low-toxicity, outpatient alternative for individuals with liver cancer and without many options. The maximal value, however, may lie in the treatment of low-risk patients.
Collapse
Affiliation(s)
| | | | | | | | - Abdullah Al-Osaimi
- Department of Gastroenterology University of Virginia Charlottesville, VA 22908-0383, USA
| | - Carl Berg
- Department of Gastroenterology University of Virginia Charlottesville, VA 22908-0383, USA
| | - Stephen H. Caldwell
- Department of Gastroenterology University of Virginia Charlottesville, VA 22908-0383, USA
| | - Patrick G. Northup
- Department of Gastroenterology University of Virginia Charlottesville, VA 22908-0383, USA
| | | | | | | |
Collapse
|
40
|
Meng MB, Cui YL, Lu Y, She B, Chen Y, Guan YS, Zhang RM. Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol 2008; 92:184-94. [PMID: 19042048 DOI: 10.1016/j.radonc.2008.11.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 10/28/2008] [Accepted: 11/01/2008] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus radiotherapy (RT) for unresectable hepatocellular carcinoma (UHCC) using meta-analysis of data from the literature involving available randomized controlled trials of TACE in combination with RT compared with that of TACE alone (Therapy I versus II) in treating UHCC. MATERIAL AND METHODS We searched the Cochrane Library, MEDLINE, CENTRAL, EMBASE, CBMdisc, and CNKI as well as employing manual searches. Meta-analysis was performed on the results of homogeneous studies. Analyses subdivided by study design were also performed. RESULTS We found 17 trials involving 1476 patients. 5 of total were Randomized Controlled Trials (RCTs) and 12 were Non-randomized Controlled Clinical Trials (CCTs). In terms of quality, 5 RCTs were graded B, and 12 CCTs were graded C. Our results showed that Therapy I, compared with Therapy II, significantly improved the survival and the tumor response of patients, and was thus more therapeutically beneficial. Serious adverse events were not increased exception for total bilirubin (TB) level. CONCLUSIONS Therapy I was more therapeutically beneficial. However, considering the strength of the evidence, additional randomized controlled trials are needed before Therapy I can be recommended routinely.
Collapse
Affiliation(s)
- Mao-Bin Meng
- Division of Thoracic Cancer, West China Hospital, West China School of Medicine, Sichuan University, #37 Guoxue Lane, Chengdu, China
| | | | | | | | | | | | | |
Collapse
|
41
|
Kim GJ, Shim SJ, Kim JH, Min CK, Chung WK. Evaluation of Real-time Measurement Liver Tumor's Movement and Synchrony™ System's Accuracy of Radiosurgery using a Robot CyberKnife. ACTA ACUST UNITED AC 2008. [DOI: 10.3857/jkstro.2008.26.4.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Gha jung Kim
- Department of Radiation Oncology, CyberKnife Center, Konyang University Hospital, Daejeon, Korea
| | - Su Jung Shim
- Department of Radiation Oncology, CyberKnife Center, Konyang University Hospital, Daejeon, Korea
| | - Jeong Ho Kim
- Department of Radiation Oncology, CyberKnife Center, Konyang University Hospital, Daejeon, Korea
| | - Chul Kee Min
- Department of Radiation Oncology, CyberKnife Center, Konyang University Hospital, Daejeon, Korea
| | - Weon-kuu Chung
- Department of Radiation Oncology, CyberKnife Center, Konyang University Hospital, Daejeon, Korea
| |
Collapse
|
42
|
Mornex F, Girard N, Beziat C, Kubas A, Khodri M, Trepo C, Merle P. Feasibility and efficacy of high-dose three-dimensional-conformal radiotherapy in cirrhotic patients with small-size hepatocellular carcinoma non-eligible for curative therapies--mature results of the French Phase II RTF-1 trial. Int J Radiat Oncol Biol Phys 2007; 66:1152-8. [PMID: 17145534 DOI: 10.1016/j.ijrobp.2006.06.015] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 06/07/2006] [Accepted: 06/07/2006] [Indexed: 02/07/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is a poor prognosis tumor, and only 20% of patients will benefit from curative therapies (surgery, liver transplantation, percutaneous ablation). Although conventional radiotherapy has been traditionally regarded as inefficient and toxic for cirrhotic patients, three-dimensional conformal radiotherapy (3DCRT) has provided promising preliminary data for the treatment of HCC. METHODS AND MATERIALS Prospective phase II trial including Child-Pugh A/B cirrhotic patients with small-size HCC (1 nodule < or =5 cm, or 2 nodules < or =3 cm) nonsuitable for curative treatments, to assess tolerance and efficacy of high-dose (66 Gy, 2 Gy/fraction) 3DCRT. RESULTS Twenty-seven patients were enrolled. Among the 25 assessable patients, tumor response was observed for 23 patients (92%), with complete response for 20 patients (80%), and partial response for 3 patients (12%). Stable disease was observed in 2 patients (8%). Grade 4 toxicities occurred in 2 of 11 (22%) Child-Pugh B patients only. Child-Pugh A patients tolerated treatment well, and 3/16 (19%) developed asymptomatic Grade 3 toxicities. CONCLUSION High-dose 3DCRT is a noninvasive, well-tolerated modality that is highly suitable for the treatment of small HCCs in cirrhotic patients, with promising results. However, additional trials are needed to optimize this technique and formally compare it with the usual curative approaches.
Collapse
Affiliation(s)
- Françoise Mornex
- Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, Lyon, France.
| | | | | | | | | | | | | |
Collapse
|
43
|
Girard N, Mornex F, Trepo C, Merle P. Place de la radiothérapie dans la stratégie de traitement du carcinome hépatocellulaire. ONCOLOGIE 2007. [DOI: 10.1007/s10269-007-0650-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
44
|
Kim JH, Park JW, Kim TH, Koh DW, Lee WJ, Kim CM. Hepatitis B virus reactivation after three-dimensional conformal radiotherapy in patients with hepatitis B virus-related hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2007; 69:813-9. [PMID: 17524569 DOI: 10.1016/j.ijrobp.2007.04.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 03/14/2007] [Accepted: 04/03/2007] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate whether three-dimensional conformal radiotherapy (3D-CRT) influences hepatitis B virus (HBV) reactivation and chronic hepatitis B (CHB) exacerbation in patients with HBV-related hepatocellular carcinoma (HCC). METHODS AND MATERIALS Of the 48 HCC patients with HBV who underwent 3D-CRT to the liver, 16 underwent lamivudine therapy before and during 3D-CRT (Group 1) and 32 did not receive antiviral therapy before 3D-CRT (Group 2). To analyze spontaneous HBV reactivation, we included a control group of 43 HCC patients who did not receive any specific treatment for HCC or CHB. RESULTS The cumulative rate of radiation-induced liver disease for Groups 1 and 2 was 12.5% (2 of 16) and 21.8% (7 of 32), respectively (p > 0.05). The cumulative rate of HBV reactivation was significantly greater in Group 2 (21.8%, 7 of 32) than in Group 1 (0%, 0/16) or the control group (2.3%, 1 of 43; p < 0.05 each). The cumulative rate of CHB exacerbation, however, did not differ significantly between Groups 2 (12.5%, 4 of 32) and 1 (0%, 0 of 16) or the control group (2.3%, 1 of 43; p > 0.05 each). The CHB exacerbations in the 4 Group 2 patients had radiation-induced liver disease features but were differentiated by serum HBV DNA changes. Two of these patients required antiviral therapy and effectively recovered with lamivudine therapy. CONCLUSIONS In patients with HBV-related HCC undergoing 3D-CRT, HBV reactivation and consequent CHB exacerbation should be considered in the differential diagnosis of radiation-induced liver disease, and antiviral therapy might be considered for the prevention of liver function deterioration after RT.
Collapse
Affiliation(s)
- Ji Hoon Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Gyeonggi 411-764, South Korea
| | | | | | | | | | | |
Collapse
|
45
|
Liang PC, Ch'ang HJ, Hsu C, Tseng SS, Shih TTF, Wu Liu T. Dynamic MRI signals in the second week of radiotherapy relate to treatment outcomes of hepatocellular carcinoma: a preliminary result. Liver Int 2007; 27:516-28. [PMID: 17403192 DOI: 10.1111/j.1478-3231.2007.01456.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
AIM Radiotherapy (RT) has been used to treat hepatocellular carcinoma (HCC) in recent years. Despite its good local control, slow tumoral shrinkage and rapid recurrence compromise treatment outcomes. We evaluated the signal intensity of the hepatic parenchyma and tumours by using dynamic contrast enhanced magnetic resonance imaging (MRI) and correlated the findings with clinical outcomes. Nineteen patients with advanced HCC received 50 Gy in 25 fractions. They underwent a dynamic contrast-enhanced, turbo fast low-angle shot MR sequence at 1.5 T before therapy, at 2 weeks of therapy, and 1 month (week 9) later. Initial first-pass enhancement slopes (slope) and peak enhancement ratios (peak) were measured. RESULTS Initial signal intensities were not associated with RT outcomes. An increased slope and peak of the tumour at week 2 was associated with an improved local response (P<0.05). In the parenchyma, an increased slope at week 2 was associated with recurrence outside the radiation fields or with progression over distant sites (P<0.05). The differences in signal changes at week 2 during RT were not persistent at a statistically significant level at 1 month after RT. CONCLUSION Dynamic contrast-enhanced MRI signals may act as biomarkers for early prediction of responses to RT in patients with HCC. Signal intensities at week 2 are important in evaluating treatment outcomes.
Collapse
Affiliation(s)
- Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
46
|
Zhou ZH, Liu LM, Chen WW, Men ZQ, Lin JH, Chen Z, Zhang XJ, Jiang GL. Combined therapy of transcatheter arterial chemoembolisation and three-dimensional conformal radiotherapy for hepatocellular carcinoma. Br J Radiol 2006; 80:194-201. [PMID: 17038412 DOI: 10.1259/bjr/33521596] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To evaluate the toxicity and efficacy of combined therapy of three-dimensional conformal radiotherapy (3DCRT) and transcatheter arterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC). 50 HCC patients treated by combined TACE and 3DCRT were selected from a patient database. Sequence of treatments was that TACE was performed first, followed by 3DCRT with an interval of about 4 weeks between. TACE was administered by 5-Fu 500-600 mg m(-2), cis-platinum 30-40 mg m(-2), epi-adriamycin 40-60 mg m(-2) mixed with iodized oil and Gelfoam embolisation. A median of two courses of TACE was given. 3DCRT was delivered by 4-6 coplanar or non-coplanar fields. The mean tumour dose was 43.0+/-6.3 Gy by conventional fractionation (2 Gy per fraction, five fractions a week), and mean dose to normal liver, 19.1+/-6.3 Gy. Acute hepatic toxicities were notable in five patients (10%) with Common Toxicity Criteria (CTC) grade 1 in two cases and grade 3 in three patients, but all recovered eventually. Two patients developed radiation-induced liver disease (RILD) and died soon after the onset of RILD. Four patients had Radiation Therapy Oncology Group (RTOG) grade 1 acute gastrointestinal complication and one patient had acute gastrointestinal bleeding. Five patients experienced RTOG Grade 1 leukopenia and Grade 2 in five cases. Nine patients achieved have partial response, and 37 patients were in stable disease. Four patients were observed to have progressive disease. The overall survival rates at 1 year, 2 years and 3 years were 60%, 38% and 28%, respectively, with a median survival period of 17 months. Irradiation dose, T-stage and hepatic cirrhosis were identified as independent predictors for overall survival by Cox proportional regression analysis. The 1 year, 2 years and 3 years local progression-free rates were 74%, 57% and 38%, and the 1 year, 2 years and 3 years distant metastasis rates were 15%, 21% and 40%, respectively. The combined modality of TACE and 3DCRT was tolerable for the majority of HCC patients, resulted in good outcome and warrants for further prospective trial.
Collapse
Affiliation(s)
- Z-H Zhou
- Department of Integrative Chinese and Western Medicine, Fudan University Cancer Hospital, Shanghai 200032, China
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Liang SX, Zhu XD, Xu ZY, Zhu J, Zhao JD, Lu HJ, Yang YL, Chen L, Wang AY, Fu XL, Jiang GL. Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance. Int J Radiat Oncol Biol Phys 2006; 65:426-34. [PMID: 16690430 DOI: 10.1016/j.ijrobp.2005.12.031] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 12/13/2005] [Accepted: 12/15/2005] [Indexed: 02/08/2023]
Abstract
PURPOSE To identify risk factors relevant to radiation-induced liver disease (RILD) and to determine the hepatic tolerance to radiation. METHODS AND MATERIALS The data of 109 primary liver carcinomas (PLC) treated with hypofractionated three-dimensional conformal radiation therapy (3D-CRT) were analyzed. Seventeen patients were diagnosed with RILD and 13 of 17 died of it. RESULTS The risk factors for RILD were late T stage, large gross tumor volume, presence of portal vein thrombosis, association with Child-Pugh Grade B cirrhosis, and acute hepatic toxicity. Multivariate analyses demonstrated that the severity of hepatic cirrhosis was a unique independent predictor. For Child-Pugh Grade A patients, the hepatic radiation tolerance was as follows: (1) Mean dose to normal liver (MDTNL) of 23 Gy was tolerable. (2) For cumulative dose-volume histogram, the tolerable volume percentages would be less than: V5 of 86%, V10 of 68%, V15 of 59%, V20 of 49%, V25 of 35%, V30 of 28%, V35 of 25%, and V40 of 20%. (3) Tolerable MDTNL could be estimated by MDTNL (Gy) = -1.686 + 0.023 * normal liver volume (cm3). CONCLUSION The predominant risk factor for RILD was the severity of hepatic cirrhosis. The hepatic tolerance to radiation could be estimated by dosimetric parameters.
Collapse
Affiliation(s)
- Shi-Xiong Liang
- Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Salem R, Lewandowski RJ, Atassi B, Gordon SC, Gates VL, Barakat O, Sergie Z, Wong CYO, Thurston KG. Treatment of unresectable hepatocellular carcinoma with use of 90Y microspheres (TheraSphere): safety, tumor response, and survival. J Vasc Interv Radiol 2006; 16:1627-39. [PMID: 16371529 DOI: 10.1097/01.rvi.0000184594.01661.81] [Citation(s) in RCA: 279] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To present safety and efficacy results obtained in treatment of a cohort of patients with unresectable hepatocellular carcinoma (HCC) with use of 90Y microspheres (TheraSphere). PATIENTS AND METHODS Forty-three consecutive patients with HCC were treated with 90Y microspheres over a 4-year period. Patients were treated by liver segment or lobe on one or more occasions based on tumor distribution, liver function, and vascular flow dynamics. Patients were followed for adverse events, objective tumor response, and survival. Patients were stratified into three risk groups according to method of treatment and risk stratification (group 0, segmental; group 1, lobar low-risk; group 2, lobar high-risk) and Okuda and Child-Pugh scoring systems. RESULTS Based on follow-up data from 43 treated patients, 20 patients (47%) had an objective tumor response based on percent reduction in tumor size and 34 patients (79%) had a tumor response when percent reduction and/or tumor necrosis were used as a composite measure of tumor response. There was no statistical difference among the three risk groups with respect to tumor response. Survival times from date of diagnosis were different among the risk groups (P < .0001). Median survival times were 46.5 months, 16.9 months, and 11.1 months for groups 0, 1, and 2, respectively. Median survival times of 24.4 months and 12.5 months by Okuda scores of I and II, respectively, were achieved (mean, 25.8 months vs 13.1). Patients had median survival times of 20.5 months and 13.8 months according to Child class A and class B/C disease, respectively (mean, 22.7 months vs 13.6 months). Patients classified as having diffuse disease exhibited decreased survival and reduced tumor response. There were no life-threatening adverse events related to treatment. CONCLUSIONS Use of 90Y microspheres (TheraSpheres) provides a safe and effective method of treatment for a broad spectrum of patients presenting with unresectable HCC. Further investigation is warranted.
Collapse
Affiliation(s)
- Riad Salem
- Division of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Hsu WC, Chan SC, Ting LL, Chung NN, Wang PM, Ying KS, Shin JS, Chao CJ, Lin GD. Results of three-dimensional conformal radiotherapy and thalidomide for advanced hepatocellular carcinoma. Jpn J Clin Oncol 2006; 36:93-9. [PMID: 16517834 DOI: 10.1093/jjco/hyi242] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of three-dimensional conformal radiotherapy and thalidomide in the treatment of advanced hepatocellular carcinoma. METHODS Between 1999 and 2003, 121 patients (mean age, 54.4 +/- 12.4 years; range, 20-81 years) with advanced hepatocellular carcinoma received three-dimensional conformal radiotherapy and thalidomide. Radiation was delivered in 1.5 Gy fractions twice daily for 5 days a week, for a total dose of 45-75 Gy. Mean treatment volume was 429.52 +/- 408.50 cm(3) (range, 26.89-2284.82 cm(3)). Thalidomide was given concomitantly: 200 mg/day in 109 patients, 300 mg/day in 8 patients and 400 mg/day in 4 patients. Treatment responses, survival rates and factors affecting survival were analyzed. RESULTS Treatment responses were observed in 61% of the patients. Liver cirrhosis (P = 0.001) and tumor size (P = 0.001) significantly affected the tumor responses. Overall survival at 6, 12 and 24 months was 84.8, 60.0 and 44.6%, respectively. On univariate analysis, liver cirrhosis (P = 0.003), Karnofsky performance status (P = 0.007), tumor size (P < 0.001), portal vein tumor thrombosis (P < 0.001) and alpha-fetoprotein level (P = 0.003) were shown to significantly affect survival. On multivariate analysis, only thrombosis (P = 0.039) and alpha-fetoprotein level (P = 0.006) were shown to be factors affecting survival. CONCLUSIONS Three-dimensional conformal radiotherapy with thalidomide seems to be effective in the treatment of advanced hepatocellular carcinoma.
Collapse
Affiliation(s)
- Wei-Chung Hsu
- Department of Radiation Oncology, Cheng-Ching General Hospital, Taichung, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Shim SJ, Seong J, Han KH, Chon CY, Suh CO, Lee JT. Local radiotherapy as a complement to incomplete transcatheter arterial chemoembolization in locally advanced hepatocellular carcinoma. Liver Int 2005; 25:1189-96. [PMID: 16343071 DOI: 10.1111/j.1478-3231.2005.01170.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE In order to determine the effect of additional radiotherapy (RT) after an incomplete transcatheter arterial chemoembolization (TACE) in an unresectable hepatocellular carcinoma (HCC), the treatment results of patients receiving TACE plus RT were analyzed and compared with those treated with TACE alone. MATERIALS AND METHODS One hundred and five patients with an unresectable HCC were treated with TACE from January 1992 to December 2002. In 73 of these patients, the TACE was incomplete. Among them, TACE was repeatedly performed in 35 patients (TACE group), and the remaining 38 patients were also treated with local RT (TACERT group). The patients were either in stage III or IVa, Eastern Cooperative Oncology Group 2 or less, and Child-Pugh class A or B. The average frequency of TACE prior to RT was 2 and the RT was started within 7-10 days after the TACE. RESULTS The 2-year survival rate was significantly higher in the TACERT than in the TACE group (36.8 % vs. 14.3%, P=0.001). According to the tumor size, the 2-year survival rates in the TACERT and TACE groups were 63% vs. 42% in 5-7 cm (P=0.22), 50% vs. 0% in 8-10 cm (P=0.03), and 17% vs. 0% in larger than 10 cm (P=0.0002) respectively. CONCLUSION There was a significantly improved survival rate in the TACERT group of unresectable HCC patients than in the TACE group, particularly in case of tumors > or =8 cm in diameter. Therefore, RT in addition to TACE is strongly recommended for patients with an unresectable HCC.
Collapse
Affiliation(s)
- Su Jung Shim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|