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Hong TS, Wo JY, Borger DR, Yeap BY, McDonnell EI, Willers H, Blaszkowsky LS, Kwak EL, Allen JN, Clark JW, Tanguturi S, Goyal L, Murphy JE, Wolfgang JA, Drapek LC, Arellano RS, Mamon HJ, Mullen JT, Tanabe KK, Ferrone CR, Ryan DP, Iafrate AJ, DeLaney TF, Zhu AX. Phase II Study of Proton-Based Stereotactic Body Radiation Therapy for Liver Metastases: Importance of Tumor Genotype. J Natl Cancer Inst 2017; 109:3852626. [PMID: 28954285 DOI: 10.1093/jnci/djx031] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/08/2017] [Indexed: 01/11/2023] Open
Abstract
Background We evaluated the efficacy and safety of risk-adapted, proton-based stereotactic body radiation therapy (SBRT) for liver metastases from solid tumors. Methods This single-arm phase II single institutional study (NCT01239381) included patients with limited extrahepatic disease, 800 mL or greater of uninvolved liver, and no cirrhosis or Child-Pugh A, who had received proton-based SBRT to one to four liver metastases from solid tumors. Treatment comprised 30 to 50 Gray equivalent (GyE) in five fractions based on the effective volume of liver irradiated. Sample size was calculated to determine if local control (LC) at one year was greater than 70%. The cumulative incidence of local failure was used to estimate LC. The association of tumor characteristics, including genetic alterations in common cancer genes such as BRAF, EGFR, HER2, KRAS, NRAS, PIK3CA, and TP53 with local tumor control, was assessed. All statistical tests were two-sided. Results Eighty-nine patients were evaluable (colorectal, n = 34; pancreatic, n = 13; esophagogastric, n = 12; other, n = 30). Median tumor size was 2.5 cm (range = 0.5-11.9 cm). Median dose was 40 GyE (range = 30-50 GyE), and median follow-up was 30.1 months (range = 14.7-53.8 months). There was no grade 3 to 5 toxicity. Median survival time was 18.1 months. The one- and three-year LC rates were 71.9% (95% confidence limit [CL] = 62.3% to 80.9%) and 61.2% (95% CL = 50.8% to 71.8%), respectively. For large tumors (≥6 cm), one-year LC remained high at 73.9% (95% CL = 54.6% to 89.8%). Mutation in the KRAS oncogene was the strongest predictor of poor LC (P = .02). Tumor with both mutant KRAS and TP53 were particularly radioresistant, with a one-year LC rate of only 20.0%, compared with 69.2% for all others (P = .001). Conclusions We report the largest prospective evaluation to date of liver SBRT for hepatic metastases, and the first with protons. Protons were remarkably well tolerated and effective even for metastases that were 6 cm or larger. KRAS mutation is a strong predictor of poor LC, stressing the need for tumor genotyping prior to SBRT and treatment intensification in this patient subset.
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Affiliation(s)
- Theodore S Hong
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Jennifer Y Wo
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Darrell R Borger
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Beow Y Yeap
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Erin I McDonnell
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Henning Willers
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Lawrence S Blaszkowsky
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Eunice L Kwak
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Jill N Allen
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Jeffrey W Clark
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Shyam Tanguturi
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Lipika Goyal
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Janet E Murphy
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - John A Wolfgang
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Lorraine C Drapek
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ronald S Arellano
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Harvey J Mamon
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - John T Mullen
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kenneth K Tanabe
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Cristina R Ferrone
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - David P Ryan
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - A John Iafrate
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Thomas F DeLaney
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Andrew X Zhu
- Department of Radiation Oncology, Department of Pathology, Division of Biostatistics, Department of Medicine, Division of Medical Oncology, Department of Medicine, Department of Radiology, and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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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.
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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.
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