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Anderson C, Chin HM, Hoverson J, Court C, Wagner T, Newman NB. Treatment of localized hepatocellular carcinoma: resection vs. ablation vs. radiation. Ann Palliat Med 2024; 13:344-354. [PMID: 38373778 DOI: 10.21037/apm-23-486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/07/2023] [Indexed: 02/21/2024]
Abstract
Hepatocellular carcinoma (HCC) is a common malignancy with many patients presenting with local disease. As of date, the use of radiation is not included in the commonly utilized Barcelona Clinic Liver Cancer (BCLC) classification but is in the National Comprehensive Cancer Network guidelines. Radiation can volumetrically cover the entire tumor and with novel technologic advances can be administered non-invasively with excellent clinical outcomes with few adverse events. The gold standard for localized early HCC (such as BCLC-A) is resection or transplantation. In patients who are not candidates for surgical treatment, locoregional therapy should be considered as an optimal therapy for these patients. Tumor ablation techniques such as microwave ablation (MWA) and radiofrequency ablation (RFA) are excellent tools to control local disease or bridge to transplantation. Should these not be possible though then ablation with external beam radiation is also capable of yielding comparable local control and serve as a bridge to transplant without worse rates of adverse events. For tumors that meet Milan criteria for transplantation, in comparison to transarterial chemoembolization (TACE), there is considerable randomized evidence demonstrating better local control, less adverse events, better progression-free survival (PFS), and less costly. It can be utilized as a bridge in Barcelona liver class B. For larger localized tumors though (extrahepatic disease or vascular invasion like BCLC-C), stereotactic body radiation therapy (SBRT) is shown via a randomized clinical trial to have a survival benefit, local control benefit, and no worse adverse events compared to systemic therapy. In this setting, it should be considered the local consolidation standard of care.
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Affiliation(s)
- Clark Anderson
- Department of Radiation Oncology, Mays Cancer Center, UT Health Sciences of San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Haelee Mia Chin
- Department of Radiation Oncology, Mays Cancer Center, UT Health Sciences of San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - John Hoverson
- Department of Radiation Oncology, Mays Cancer Center, UT Health Sciences of San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Colin Court
- Department of Surgical Oncology, Mays Cancer Center, UT Health Sciences of San Antonio, San Antonio, TX, USA
| | - Timothy Wagner
- Department of Radiation Oncology, Mays Cancer Center, UT Health Sciences of San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Neil B Newman
- Department of Radiation Oncology, Mays Cancer Center, UT Health Sciences of San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
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Hurmuz P, Cengiz M, Ozyigit G, Yuce Sari S, Kahvecioglu A, Beduk Esen CS, Yalcin S, Zorlu F. Stereotactic Body Radiotherapy as an Effective Treatment for Pancreatic Cancer. Cureus 2023; 15:e38255. [PMID: 37252548 PMCID: PMC10225161 DOI: 10.7759/cureus.38255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) allows the delivery of an ablative radiation dose to the tumor with minimal toxicity. Although magnetic resonance imaging (MRI)-guided SBRT appears to be a promising approach in the modern era, X-ray image-guided SBRT is still used worldwide for pancreatic cancer. This study aims to evaluate the results of X-ray image-guided SBRT in patients with locally advanced pancreatic cancer (LAPC). Methodology Medical records of 24 patients with unresectable LAPC who underwent X-ray image-guided SBRT between 2009 and 2022 were retrospectively evaluated. SPSS version 23.0 (IBM Corp., Armonk, NY, USA) was utilized for all analyses. Results The median age was 64 years (range = 42-81 years), and the median tumor size was 3.5 cm (range = 2.7-4 cm). The median total dose of SBRT was 35 Gy (range = 33-50 Gy) in five fractions. After SBRT, 30% of patients showed complete and 41% showed partial response, whereas 20% had stable disease and 9% had progression. Median follow-up was 15 months (range = 6-58 months). During follow-up, four (16%) patients had local recurrence, one (4%) had a regional recurrence, and 17 (70%) had distant metastasis (DM). The two-year local control (LC), local recurrence-free survival (LRFS), overall survival (OS), and DM-free survival (DMFS) rate was 87%, 36%, 37%, and 29%, respectively. In univariate analysis, a larger tumor size (>3.5 cm) and higher cancer antigen 19-9 level (>106.5 kU/L) significantly decreased the OS, LRFS, and DMFS rates. No severe acute toxicity was observed. However, two patients had severe late toxicity as intestinal bleeding. Conclusions X-ray image-guided SBRT provides a good LC rate with minimal toxicity for unresectable LAPC. However, despite modern systemic treatments, the rate of DM remains high which plays a major role in survival.
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Affiliation(s)
- Pervin Hurmuz
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Mustafa Cengiz
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Gokhan Ozyigit
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Sezin Yuce Sari
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Alper Kahvecioglu
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | | | - Suayib Yalcin
- Medical Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Faruk Zorlu
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
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Ma MW, Li HZ, Gao XS, Liu MZ, Yin H, Yang KW, Chen JY, Ren XY, Wang D. Outcomes of High-Dose Stereotactic Ablative Radiotherapy to All/Multiple Sites for Oligometastatic Renal Cell Cancer Patients. Curr Oncol 2022; 29:7832-7841. [PMID: 36290896 PMCID: PMC9600736 DOI: 10.3390/curroncol29100619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Stereotactic ablative body radiotherapy (SABR) is one of the treatment options for oligometastatic renal cell carcinoma (RCC) but is limited by a lack of data to evaluate high-dose SABR to all/multiple sites. OBJECTIVE This study retrospectively investigated the efficacy and prognostic factors of high-dose SABR for oligometastatic RCC patients. DESIGN, SETTING, AND PARTICIPANTS Patients with oligometastatic RCC on systemic therapy were retrospectively collected. INTERVENTION(S) All patients were treated with SABR (40-50 Gy/5 fractions) for small tumors or partial-SABR (tumor center boosted with 6-8 Gy/3-5 fractions with 50-60 Gy/20-25 fractions to the whole tumor volume) for bulky tumors or tumors adjacent to critical organs. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS AND LIMITATIONS In total, 35 patients were enrolled, of which 88.5% had intermediate- or high-risk disease, with 60% on second- to fourth-line systemic therapy. The median follow-up time was 17 months. The median PFS and OS times were 11.3 and 29.7 months, respectively. Univariate analysis showed that an OS benefit was found in patients who received radiation before tyrosine kinase inhibitor (TKI) failure (p = 0.006) and where there was a short time interval (<six months) from being diagnosed with metastatic disease to undergoing radiotherapy (p = 0.046). Similar results were also found in PFS in patients who received radiation before TKI failure (p = 0.049) or within eight months (p = 0.047). There were certain differences in PFS (p = 0.033) between patients receiving radiotherapy with all lesions and those with selected tumors. In multivariate analysis, OS benefits were found in patients who received radiotherapy before TKI failure (p = 0.028). The limitations of this study include its retrospective design and the small patient cohort. CONCLUSIONS The early use of high-dose SABR to multi-lesions may improve survival. Partial-SABR for bulky lesions close to critical organs could be safely and effectively applied under certain circumstances.
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Affiliation(s)
- Ming-Wei Ma
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
| | - Hong-Zhen Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
- Correspondence: (X.-S.G.); (D.W.); Tel.: +86-010-83575641 (X.-S.G.); +1-312-942-5751 (D.W.); Fax: +86-010-66551788 (X.-S.G.); +1-312-942-2829 (D.W.)
| | - Ming-Zhu Liu
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
| | - Huan Yin
- Department of Health Science & Technology Strategy Information, Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China
| | - Kai-Wei Yang
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Jia-Yan Chen
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
| | - Xue-Ying Ren
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL 60612, USA
- Correspondence: (X.-S.G.); (D.W.); Tel.: +86-010-83575641 (X.-S.G.); +1-312-942-5751 (D.W.); Fax: +86-010-66551788 (X.-S.G.); +1-312-942-2829 (D.W.)
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Taylor JM, Song A, David AR, Chen VE, Lu B, Werner-Wasik M. Impact of Sarcopenia on Survival in Patients With Early-Stage Lung Cancer Treated With Stereotactic Body Radiation Therapy. Cureus 2020; 12:e10712. [PMID: 33014666 PMCID: PMC7526967 DOI: 10.7759/cureus.10712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Sarcopenia has been associated with poor survival among cancer patients. Normalized total psoas area (NTPA) has been used as a surrogate for defining sarcopenia. Few data exist characterizing the impact of sarcopenia and other metrics of fitness on clinical outcomes in patients with early-stage non-small cell lung cancer (NSCLC) treated non-invasively with stereotactic body radiotherapy (SBRT). Methods To assess the association between sarcopenia and clinical outcomes, we conducted a retrospective analysis of consecutive patients treated with SBRT from 2013 to 2019 . Overall survival (OS), local failure free survival (LFS), distant failure free survival (DFS), NTPA, body mass index (BMI), and Charlson comorbidity index (CCI) were included for analysis. NTPA was calculated by measuring the psoas volume at the L3 vertebra and normalizing for patient height and gender. Survival functions were evaluated using the Kaplan-Meier method. Log-rank test and Cox-proportional hazards were performed for categorical and continuous variables, respectively. Significance was set as p < 0.05. Results A total of 91 patients met the criteria. The median age was seven years and Karnofsky Performance Status score (KPS) was 80 (range: 60-100). Approximately 79% of patients had T1 tumors. Median radiation dose and number of fractions were 60 Gy (range: 45-60) and 5 fractions (range: 3-5). Median NTPA was 531.16 mm2/m2 (range: 90.4-1356.2). After normalization (sarcopenia: <385 mm2/m2, female; <585 mm2/m2, male), 39 patients (42.8%) had sarcopenia. NTPA had no association with OS (p = 0.7), LFS (p = 0.9), or DFS (p = 0.5). Increasing BMI was associated with improved OS (HR 0.90, 95% CI 0.83-0.98). With a median follow-up of 23.4 months, median OS was 60, 60, and 45.9 months (p = 0.37) in all patients, non-sarcopenic patients, and sarcopenic patients, respectively. Conclusion Sarcopenia was not associated with OS, LFS, or DFS. Increasing BMI is associated with improved OS. Future, prospective work is needed to define the impact of sarcopenia and other fitness metrics on clinical outcomes among NSCLC patients treated non-invasively with SBRT.
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Affiliation(s)
- James M Taylor
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - Andrew Song
- Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Allison R David
- Radiation Oncology, Sidney Kimmel Medical College, Philadelphia, USA.,Internal Medicine, Boston Medical Center, Boston, USA
| | - Victor E Chen
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - Bo Lu
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - Maria Werner-Wasik
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
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Wada Y, Hashimoto M. Modern evidence and future prospects of external body radiation therapy for lung oligometastases of breast cancer. Transl Cancer Res 2020; 9:5077-5086. [PMID: 35117873 PMCID: PMC8799217 DOI: 10.21037/tcr.2020.02.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 02/12/2020] [Indexed: 12/25/2022]
Abstract
After Hellman and Weichselbaum defined "Oligometastasis" in 1995, several local therapies for lung oligometastases including surgical resection and external body radiation therapy were reported that improved local control (LC) and progression-free survival, overall survival, and quality of life. This suggests that oligometastases is a potentially curable state. Modern advances in radiation therapy such as stereotactic body radiation therapy (SBRT) in which high dose coverage of target lesion without exposure of normal organ is possible, and are widely used to treat solitary or a limited number of primary lung cancer and metastases. Several reports showed that SBRT was a useful treatment method for lung oligometastases, and the LC rate of SBRT was 80-90% in 2 years and less invasive than surgical resection. SBRT is a safe and effective especially for small and peripheral lung metastases. However, if the metastatic lesion is big or centrally located, careful treatment is necessary to prevent radiation pneumonitis. After SBRT, it is sometimes difficult to differentiate local recurrence and pulmonary injury, especially in the early phase. However, it is important to detect local recurrence especially in patients who require further local therapy such as surgical resection and re-irradiation or systemic therapy. The diagnosis can be improved by determining the natural course after SBRT and local recurrence with computed tomography imaging and 18F-fluorodeoxyglucose positron emission tomography, respectively. Moreover, radiation therapy may have both local and systemic effects that are related to the enhancement of immune-response after radiation. Currently, several trials evaluating the benefits of SBRT for oligometastatic breast cancer are underway. However, the adaption of SBRT for lung metastases including other treatment strategies should be carefully discussed by the radiation oncologist and a multi-disciplinary team comprising a breast surgeon, medical oncologist, diagnostic radiologist, and radiation oncologist, among others.
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Affiliation(s)
- Yuki Wada
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita 010-8543, Japan
| | - Manabu Hashimoto
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita 010-8543, Japan
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