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Prince DS, Schlaphoff G, Davison SA, Huo YR, Xiang H, Chan MV, Lee AU, Thailakanathan C, Jebeili H, Rogan C, Al-Omary A, Gupta S, Lockart I, Tiwari N, Clark-Dickson M, Hillhouse JW, Laube R, Chang J, Nguyen V, Danta M, Cheng R, Strasser SI, Zekry A, Levy MT, Chan C, Liu K. Selective internal radiation therapy for hepatocellular carcinoma: A 15-year multicenter Australian cohort study. J Gastroenterol Hepatol 2022; 37:2173-2181. [PMID: 36031345 DOI: 10.1111/jgh.15986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIM The exact place for selective internal radiation therapy (SIRT) in the therapeutic algorithm for hepatocellular carcinoma (HCC) is debated. There are limited data on its indications, efficacy, and safety in Australia. METHODS We performed a multicenter retrospective cohort study of patients undergoing SIRT for HCC in all Sydney hospitals between 2005 and 2019. The primary outcome was overall survival. Secondary outcomes were progression-free survival and adverse events. RESULTS During the study period, 156 patients underwent SIRT across 10 institutions (mean age 67 years, 81% male). SIRT use progressively increased from 2005 (n = 2), peaking in 2017 (n = 42) before declining (2019: n = 21). Barcelona Clinic Liver Cancer stages at treatment were A (13%), B (33%), C (52%), and D (2%). Forty-four (28%) patients had tumor thrombus. After a median follow-up of 13.9 months, there were 117 deaths. Median overall survival was 15 months (95% confidence interval 11-19). Independent predictors of mortality on multivariable analysis were extent of liver involvement, Barcelona Clinic Liver Cancer stage, baseline ascites, alpha fetoprotein, and model for end-stage liver disease score. Median progression-free survival was 6.0 months (95% confidence interval 5.1-6.9 months). Following SIRT, 11% of patients were downstaged to curative therapy. SIRT-related complications occurred in 17%: radioembolization-induced liver disease (11%), pneumonitis (3%), gastrointestinal ulceration, and cholecystitis (1% each). Baseline ascites predicted for radioembolization-induced liver disease. CONCLUSION We present the largest Australian SIRT cohort for HCC. We have identified several factors associated with a poor outcome following SIRT. Patients with early-stage disease had the best survival with some being downstaged to curative therapy.
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Affiliation(s)
- David Stephen Prince
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Glen Schlaphoff
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Scott Anthony Davison
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Ya Ruth Huo
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Hao Xiang
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Michael Vinchill Chan
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Alice Unah Lee
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Cynthuja Thailakanathan
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - Hazem Jebeili
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - Christopher Rogan
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Ahmed Al-Omary
- Gastroenterology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sidhartha Gupta
- Gastroenterology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ian Lockart
- Gastroenterology Department, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Neha Tiwari
- Department of Gastroenterology and Hepatology, Nepean Hospital, Sydney, New South Wales, Australia
| | | | | | - Robyn Laube
- Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Jeff Chang
- Department of Gastroenterology and Hepatology, Nepean Hospital, Sydney, New South Wales, Australia.,Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Vi Nguyen
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mark Danta
- Gastroenterology Department, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Robert Cheng
- Gastroenterology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Simone Irene Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - Miriam Tania Levy
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Christine Chan
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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McAleese J, Tumelty K, Baluch S, Powell C, Drinkwater K. Assessment of the Implementation of Lung Cancer Consensus Statements From the Royal College of Radiologists in 2021; Progress and Barriers. Clin Oncol (R Coll Radiol) 2022; 34:e463-e471. [PMID: 36109283 DOI: 10.1016/j.clon.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/02/2022] [Accepted: 07/22/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lung cancer outcomes in the UK are worse than those in many similar countries. The RCR developed a series of 43 consensus statements (CS) to facilitate improvements in care for patients treated with radiotherapy. METHODS We asked all 61 UK radiotherapy centres to self-assess the implementation of the CS and to describe their departmental key strengths and weaknesses in September 2021. RESULTS 87% of centres returned their assessments. Whilst developmental activity was seen in most areas for most centres, 24 of the statements were felt to be difficult to implement within the next 2 years by at least one centre. The most frequently reported strengths were in the implementation of SABR (stereotactic body radiotherapy), concurrent chemoradiation for non-small cell lung cancer and technological aspects of treatment planning. The most frequently described departmental weaknesses were in pre-habilitation, timeliness of PET/CT scans and prophylaxis for Pneumocystis jiroveci Pneumonia (PJP). Barriers to implementation were often due to insufficient resource, a requirement for organisations to work together, and a perceived lack of evidence base. Strengths were often attributed to good team working, a local champion and being an early adopter. CONCLUSIONS This work confirms the commitment of lung cancer radiotherapy teams across the UK to improve outcomes for their patients. Most of the statements have been implemented at least partially. Themes have been identified to aid further progress, one of which is a requirement for significant investment.
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Affiliation(s)
- J McAleese
- Northern Ireland Cancer Centre, Belfast, UK
| | - K Tumelty
- Northern Ireland Cancer Centre, Belfast, UK.
| | - S Baluch
- Queen Alexandra Hospital, Portsmouth, UK
| | - C Powell
- Velindre Cancer Centre, Cardiff, UK
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Open issues in the therapeutic management of unresectable stage III NSCLC in the immunotherapy era. Crit Rev Oncol Hematol 2022; 174:103684. [PMID: 35462031 DOI: 10.1016/j.critrevonc.2022.103684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Treatment of stage III non-small cell lung cancer (NSCLC) has traditionally been controversial and challenging: multidisciplinary approach is mandatory and defining resectability is a critical issue; furthermore, patients are often frail due to age or comorbidities. After PACIFIC trial publication, a new therapeutic path has been defined for patients with unresectable NSCLC, with a prominent prognostic advantage. A trimodality treatment, with chemo-radiotherapy followed by maintenance durvalumab is now the standard of care, recommended by international guidelines. However, despite an impressive activity, the use of consolidative immunotherapy after concurrent chemoradiotherapy is highly debated in some clinically-relevant situations, including patients harboring EGFR mutations, older and/or frail patients not suitable for combined treatment, PD-L1 tumor expression. Here we report an expert virtual Italian meeting summary, where six medical oncologists and six radiation oncologists discussed all these aspects trying to underline the critical aspects and to find the possible clinical solutions.
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