Long-term clinical outcomes of patients receiving proton beam therapy for caudate lobe hepatocellular carcinoma

Tislelizumab plus anlotinib with or without radiotherapy as first-line therapy in advanced hepatocellular carcinoma: a single center, non-randomized retrospective case-control study

The purpose of this study was to investigate the efficacy and safety of tislelizumab (monoclonal antibody) plus anlotinib (tyrosine kinase inhibitor) with or without radiotherapy in advanced hepatocellular carcinoma (HCC). Ninety patients with advanced HCC were divided into two groups: tislelizumab plus anlotinib with radiotherapy (TAR group) and tislelizumab plus anlotinib (TA group) based on the treatment received. Radiotherapy was performed on two or three days during the first cycle of tislelizumab plus anlotinib. The radiotherapy requirements were dose95% ≥ 14.2-46 Gy for tumor volume. Efficacy was evaluated according to the modified Response Evaluation Criteria for Solid Tumors. Adverse events (AEs) were evaluated using the National Cancer Institute-Common Terminology Criteria for Adverse Events 4.0. The primary endpoint was the objective response rate (ORR). The secondary endpoints were progression-free survival (PFS), overall survival (OS), and the disease control rate (DCR). The ORR and DCR in the TAR group were 24.5% (62.2% and 37.7%, p = 0.03) and 22.3% higher (75.6% and 53.3%, p = 0.04), respectively, compared to the TA group. The median OS and PFS in the TAR group were prolonged 4.5 months [21.0 and 16.5 months, χ2 = 8.99, p = 0.00, 95% confidence interval (CI) 0.295-0.774] and 4.0 months (11.0 and 7.0 months. χ2 = 11.73, p = 0.00. 95% CI 0.989-2.502), respectively, compared to the TA group. The risks of disease progression and mortality in the TAR group were reduced by 53.0% (hazard ratio (HR) = 0.470, 95% CI 0.294-0.753) and 49.3% (HR = 0.507, 95% CI 0.315-0.815) compared to the TA group. The OS and PFS rates at 1 and 2 years increased by 28.9% (97.8% and 68.9%, p = 0.00) and 20.0% (42.2% and 22.2%, p = 0.07) and 28.9% (42.2% and 13.3%, p = 0.00) and 15.6% (20.0% and 4.4%, p = 0.05), respectively, in the TAR group compared to the TA group. Most patients mainly presented with grade 1/2 tolerable acute AEs (p > 0.05). No AEs were related to radiotherapy, and no fatalities occurred. The results indicate that tislelizumab plus anlotinib and radiotherapy is a safe and effective treatment for advanced HCC. Trial registration: ChiCTR2000039022 (10/13/2020). Retrospective.

Current perspectives on radiotherapy in hepatocellular carcinoma management: a comprehensive review

This review examines the transformative role of external beam radiotherapy (EBRT) in managing hepatocellular carcinoma (HCC), spotlighting the progression from traditional EBRT techniques to advanced modalities like intensity-modulated radiotherapy (RT), stereotactic body RT (SBRT), and innovative particle therapy, including proton beam therapy and carbon ion RT. These advancements have significantly improved the precision and efficacy of RT, marking a paradigm shift in the multimodal management of HCC, particularly in addressing complex cases and enhancing local tumor control. The review underscores the synergistic potential of integrating RT with other treatments like transarterial chemoembolization, systemic therapies such as sorafenib, and emerging immunotherapies, illustrating enhanced survival and disease control outcomes. The efficacy of RT is addressed for challenging conditions, including advanced HCC with macrovascular invasion, and RT modalities, like SBRT, are compared against traditional treatments like radiofrequency ablation for early-stage HCC. Additionally, the review accentuates the encouraging outcomes of particle therapy in enhancing local control and survival rates, minimizing treatment-related toxicity, and advocating for continued research and clinical trials. In conclusion, the integration of RT into multimodal HCC treatment strategies, coupled with the emergence of particle therapy, is crucial for advancing oncologic management, emphasizing the need for relentless innovation and personalized treatment approaches.

Proton beam therapy for hepatocellular carcinoma with bile duct invasion

AIM

Hepatocellular carcinoma (HCC) with bile duct invasion (BDI) (BDIHCC) has a poor prognosis. Moreover, due to the paucity of reports, there is no consensus regarding optimal management of this clinical condition yet. The aim of this study was to clarify the efficacy and safety of proton beam therapy (PBT) for BDIHCC.

METHODS

Between 2009 and 2018, 15 patients with BDIHCC underwent PBT at our institution. The overall survival (OS), local control (LC), and progression-free survival (PFS) curves were constructed using the Kaplan-Meier method. Toxicities were assessed using the Common Terminology Criteria of Adverse Events version 4.0.

RESULTS

The median follow-up time was 23.4 months (range, 7.9-54.3). The median age was 71 years (range, 58-90 years). Many patients were Child A (n = 8, 53.3%) and most had solitary tumors (n = 11, 73.3%). Additionally, most patients had central type BDI (n = 11, 73%). The median tumor size was 4.0 cm (range, 1.5-8.0 cm). The 1-, 2-, and 3-year OS rates were 80.0%, 58.7% and 40.2%, respectively, and the corresponding LC and PFS rates were 93.3%, 93.3%, and 74.7% and 72.7%, 9.7%, and 0.0%, respectively. Acute grade 1/2 dermatitis (n = 7, 46.7%), and grades 2 (n = 1, 6.7%) and 3 (n = 1, 6.7%) cholangitis were observed. Late toxicities such as grade 3 gastric hemorrhage and pleural effusion were observed. No toxicities of grade 4 or higher were observed.

CONCLUSIONS

PBT was feasible with tolerable toxicities for the treatment of BDIHCC.

Advances in the interventional therapy of hepatocellular carcinoma originating from the caudate lobe

Hepatocellular carcinoma originating from the caudate lobe, also known as segment I hepatocellular carcinoma, is difficult to treat because of its special location, complex vascular supply, and the proximity of important vessels, bile ducts, and organs. This research is conducted to examine the efficacy and safety of interventional therapy for hepatocellular carcinoma in the caudate lobe.

Conclusion

Superselective chemoembolization and ablation techniques for the treatment of caudate lobe hepatocellular carcinoma still need to be improved. The combination of multiple interventional methods and the application of multiple imaging techniques can improve the effectiveness and safety of interventional therapy for hepatocellular carcinoma in the caudate lobe. Multidisciplinary treatment is also essential to improve the prognosis of patients with caudate lobe hepatocellular carcinoma.

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The anatomical characteristics of the arteries in the caudate lobe hepatocellular carcinoma remains an important factor restricting the success rate of superselective transcatheter arterial chemoembolization.

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The application of multiple imaging techniques may improve the effectiveness and safety of interventional therapy.

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The combination of multiple interventional methods has more advantages than disadvantages.

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Multidisciplinary treatment is increasingly becoming a trend in the treatment of caudate lobe hepatocellular carcinoma.