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Mohamed AA, Berres ML, Bruners P, Lang SA, Trautwein C, Wiltberger G, Barabasch A, Eble M. Managing hepatocellular carcinoma across the stages: efficacy and outcomes of stereotactic body radiotherapy : A retrospective study. Strahlenther Onkol 2024; 200:715-724. [PMID: 38689147 PMCID: PMC11272809 DOI: 10.1007/s00066-024-02235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/17/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) poses a unique challenge due to its predilection for developing on compromised livers, often limiting surgical options. Stereotactic body radiotherapy (SBRT) has emerged as a promising local treatment modality for HCC. This study aims to assess the effectiveness of SBRT in HCC patients not suitable for surgery, focusing on local control, optimal radiation dosing, and prognostic factors. METHODS In this retrospective analysis, 52 HCC patients treated with SBRT were examined. The study assessed local control, progression-free survival (PFS), and overall survival (OS) while conducting dosimetric analyses. The relationship between mean liver dose and Child-Pugh score (CPS) progression was also explored. RESULTS SBRT demonstrated 93.4% freedom from local progression (FFLP) at 12 months. Notably, a near minimum dose (D98%) below 61 Gy as an equivalent dose in 2‑Gy fractions with α/β 10 Gy (EQD2α/β10) was associated with reduced FFLP (p-value 0.034). Logistic regression analysis revealed a dose-response relationship for FFLP and D98% with 95% and 98% probability of FFLP at a dose of 56.9 and 73.1 Gy, respectively. The study observed OS rates of 63.7% at 1 year and 34.3% at 3 years. Patients with portal vein tumor thrombus (PVTT) and larger tumors (≥ 37 cm3) experienced decreased PFS and OS. Multivariate analysis identified PVTT, larger tumor volume, and performance status as independent predictors of reduced OS. Notably, classical radiation-induced disease (cRILD) was absent, but nonclassical (nc) RILD occurred in 7.7% of patients. Regression analysis linked a mean EQD2α/β3-8 dose to the liver (12.8-12.6) with a 10% likelihood of ncRILD. CONCLUSION SBRT offers a compelling option for achieving high local control and promising survival outcomes in HCC. The study supports a radiation dose range of 61-73.1 Gy, coupled with a mean liver dose under 12.6-12.8 Gy as EQD2, to achieve favorable FFLP rates, with acceptable toxicity rates.
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Affiliation(s)
- Ahmed Allam Mohamed
- Radiation Oncology Department, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany.
| | - Marie-Luise Berres
- Gastroenterology, Hepatology and infectious Diseases Department, University Hospital RWTH Aachen, Aachen, Germany
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
| | - Philipp Bruners
- Diagnostic and IInterventional Radiology Department, University Hospital RWTH Aachen, Aachen, Germany
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
| | - Sven Arke Lang
- Visceral and Transplantation Surgery Department, University Hospital RWTH Aachen, Aachen, Germany
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
| | - Christian Trautwein
- Gastroenterology, Hepatology and infectious Diseases Department, University Hospital RWTH Aachen, Aachen, Germany
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
| | | | | | - Michael Eble
- Radiation Oncology Department, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
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Surgical resection versus transarterial chemoembolization followed by moderately hypofractionated radiotherapy in hepatocellular carcinoma. Strahlenther Onkol 2023; 199:293-303. [PMID: 36441171 DOI: 10.1007/s00066-022-02022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Transarterial chemoembolization (TACE) is the gold standard treatment in intermediate hepatocellular carcinoma (HCC), but long-term disease control rates remain low. Herein, we compared results of TACE followed by hypofractionated radiotherapy (TACE-hRT) to surgical resection (SR) in early single or paucinodular intrahepatic HCC. METHODS Between June 2004 and November 2016, data on 160 consecutive patients with Barcelona Clinic Liver Cancer (BCLC) stage A Child-Pugh A HCC treated with SR or TACE-hRT in our expert center were retrospectively reviewed. Time to progression (TTP), progression-free survival (PFS), and overall survival (OS) were evaluated. Clinical outcomes were compared using the stabilized-weights inverse probability of treatment weighting propensity score. RESULTS Ninety-eight patients underwent SR and 62 were treated by TACE-hRT. Median total dose of RT was 54 Gy (interquartile range [IQR] 54-54) in 3‑Gy fractions. Median OS follow-up was 93 months. TTP did not significantly differ between patients following SR and TACE-hRT, with 1‑year rates of 68.2% and 82.6% (p = 0.17), respectively. In contrast, PFS and OS were lower in the TACE-hRT group (p = 0.015 and p = 0.006), with a median OS of 37 vs. 63 months for patients with surgery and TACE-hRT, respectively. In multivariate analysis, a significant negative impact on PFS and OS was seen for age at diagnosis, on TTP for alcohol-related liver disease, and on OS for total number of HCC nodules. Symptomatic grade ≥ 3 adverse events were presented by 42 (42.9%) SR and 19 (30.6%) TACE-hRT patients (p = 0.17). CONCLUSION In patients presenting Child-Pugh A BCLC‑A HCC with high risk for surgical complications, TACE-hRT can be an effective and safe treatment. However, surgical management remains the standard of care whenever possible.
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Association of Multi-Phasic MR-Based Radiomic and Dosimetric Features with Treatment Response in Unresectable Hepatocellular Carcinoma Patients following Novel Sequential TACE-SBRT-Immunotherapy. Cancers (Basel) 2023; 15:cancers15041105. [PMID: 36831445 PMCID: PMC9954441 DOI: 10.3390/cancers15041105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/27/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
This study aims to investigate the association of pre-treatment multi-phasic MR-based radiomics and dosimetric features with treatment response to a novel sequential trans-arterial chemoembolization (TACE) plus stereotactic body radiotherapy (SBRT) plus immunotherapy regimen in unresectable Hepatocellular Carcinoma (HCC) sub-population. Twenty-six patients with unresectable HCC were retrospectively analyzed. Radiomic features were extracted from 42 lesions on arterial phase (AP) and portal-venous phase (PVP) MR images. Delta-phase (DeltaP) radiomic features were calculated as AP-to-PVP ratio. Dosimetric data of the tumor was extracted from dose-volume-histograms. A two-sided independent Mann-Whitney U test was used to assess the clinical association of each feature, and the classification performance of each significant independent feature was assessed using logistic regression. For the 3-month timepoint, four DeltaP-derived radiomics that characterize the temporal change in intratumoral randomness and uniformity were the only contributors to the treatment response association (p-value = 0.038-0.063, AUC = 0.690-0.766). For the 6-month timepoint, DeltaP-derived radiomic features (n = 4) maintained strong clinical associations with the treatment response (p-value = 0.047-0.070, AUC = 0.699-0.788), additional AP-derived radiomic features (n = 4) that reflect baseline tumoral arterial-enhanced signal pattern and tumor morphology (n = 1) that denotes initial tumor burden were shown to have strong associations with treatment response (p-value = 0.028-0.074, AUC = 0.719-0.773). This pilot study successfully demonstrated associations of pre-treatment multi-phasic MR-based radiomics with tumor response to the novel treatment regimen.
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Planning benchmark study for SBRT of liver metastases: Results of the DEGRO/DGMP working group stereotactic radiotherapy and radiosurgery. Int J Radiat Oncol Biol Phys 2022; 113:214-227. [PMID: 35074434 DOI: 10.1016/j.ijrobp.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/19/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate, if liver SBRT treatment planning can be harmonized across different treatment planning systems, delivery techniques and institutions by using a specific prescription method and to minimize the knowledge gap concerning inter-system and inter-user differences. To provide best practice guidelines for all used techniques. METHODS A multiparametric specification of target dose (GTVD50%, GTVD0.1cc, GTVV90%, PTVV70%) with a prescription dose of GTVD50% = 3 × 20 Gy and OAR limits were distributed with CTs and structure sets from three liver metastases patients. Thirty-five institutions provided 132 treatment plans using different irradiation techniques. These plans were first analyzed for target and OAR doses. Four different renormalization methods were performed (PTVDmin, PTVD98%, PTVD2%, PTVDmax). The resulting 660 treatments plans were evaluated regarding target doses in order to study the effect of dose renormalization to different prescription methods. A relative scoring system was used for comparisons. RESULTS GTVD50% prescription can be performed in all systems. Treatment plan harmonization was overall successful with standard deviations for Dmax, PTVD98%, GTVD98% and PTVDmean of 1.6 Gy, 3.3 Gy, 1.9 Gy and 1.5 Gy, respectively. Primary analysis showed 55 major deviations from clinical goals in 132 plans, while in only <20% of deviations GTV/PTV dose was traded for meeting OAR limits. GTVD50% prescription produced the smallest deviation from target planning objectives and between techniques, followed by the PTVDmax, PTVD98%, PTVD2% and PTVDmin prescription. Deviations were significant for all combinations but for the PTVDmax prescription compared with GTVD50% and PTVD98%. Based on the various dose prescription methods, all systems significantly differed from each other, while GTVD50% and PTVD98% prescription showed the least differences between the systems. CONCLUSIONS This study showed the feasibility of harmonizing liver SBRT treatment plans across different treatment planning systems and delivery techniques when a sufficient set of clinical goals is given.
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Mak SH, Wong SMN, Chiu WHK, Chiang CL, Yip WLW, Ho HMC, Yeung SYC, Chan KHM, Lee WYV, Lee ASF. Presence of tumour capsule on contrast-enhanced CT is associated with improved outcomes of stereotactic body radiation therapy in hepatocellular carcinoma patients. Strahlenther Onkol 2022; 198:639-647. [PMID: 34988623 DOI: 10.1007/s00066-021-01879-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is a novel local therapy for the treatment of hepatocellular carcinoma (HCC). While effective, there is currently no reliable radiological marker to guide patient selection. In this study, we investigated the prognostic value of capsule appearance on contrast-enhanced computed tomography (CT) for patients undergoing SBRT. MATERIALS AND METHODS Between 2006 and 2017, 156 consecutive patients with Child-Pugh score class A/B and HCC ≥ 5 cm who underwent SBRT were retrospectively analysed. Baseline triple-phase CTs of the abdomen were reviewed for the presence of capsule appearances and correlated with objective response rate (ORR), overall survival (OS) and pattern of treatment failure. RESULTS Capsule appearance on CT was present in 83 (53.2%) patients. It was associated with improved ORR by Response Evaluation Criteria in Solid Tumours (RECIST) (60.2 vs. 24.7%, p < 0.001) and Modified Response Evaluation Criteria in Solid Tumours (mRECIST) (78.3 vs. 34.2%, p < 0.001). The presence of a capsule was also associated with superior 2‑year local control (89.1 vs. 51.4%, p < 0.001) and 2‑year OS (34.1 vs. 14.8%, p < 0.01). Hepatic out-field failure was the dominant mode of progression, which was less common in patients with intact capsule (54.2 vs. 60.3%, p = 0.01). CONCLUSION Capsule appearance on CT could potentially be a non-invasive prognostic marker for selecting HCC patients to undergo SBRT. A larger cohort is warranted to validate our findings.
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Affiliation(s)
- Siu Hin Mak
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Wan Hang Keith Chiu
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Chi Leung Chiang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Hoi Man Connie Ho
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Ka Heng Mark Chan
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Proton Therapy Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Wan Yan Venus Lee
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Yang DS, Park S, Rim CH, Yoon WS, Shin IS, Lee HA. Salvage External Beam Radiotherapy after Incomplete Transarterial Chemoembolization for Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1000. [PMID: 34684036 PMCID: PMC8539441 DOI: 10.3390/medicina57101000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022]
Abstract
Background and objective: Although transarterial chemoembolization (TACE) has been the commonest local modality for hepatocellular carcinoma (HCC), incomplete repsonse occurs especially for tumors with a large size or difficult tumor accessment. The present meta-analysis assessed the efficacy and feasibility of external beam radiotherapy (EBRT) as a salvage modality after incomplete TACE. Materials and Methods: We systematically searched the PubMed, Embase, Medline, and Cochrane databases. The primary endpoint was overall survival (OS), and the secondary endpoints included the response ratem toxicity of grade 3, and local control. Results: Twelve studies involving 757 patients were included; the median of portal vein thrombosis rate was 25%, and the pooled median of tumor size was 5.8 cm. The median prescribed dose ranged from 37.3 to 150 Gy (pooled median: 54 Gy in *EQD2). The pooled one- and two-year OS rates were 72.3% (95% confidence interval (CI): 60.2-81.9%) and 50.5% (95% CI: 35.6-65.4%), respectively; the pooled response and local control rates were 72.2% (95% CI: 65.4-78.1%) and 86.6 (95% CI: 80.1-91.2%) respectively. The pooled rates of grade ≥3 gastrointestinal toxicity, radiation-induced liver disease, hepatotoxicity, and hematotoxicity were 4.1%, 3.5%, 5.7%, and 4.9%, respectively. Local control was not correlated with intrahepatic (p = 0.6341) or extrahepatic recurrences (p = 0.8529) on meta-regression analyses. Conclusion: EBRT was feasible and efficient in regard to tumor response and control; after incomplete TACE. Out-field recurrence, despite favorable local control, necessitates the combination of EBRT with systemic treatments. *Equivalent dose in 2 Gy per fraction scheme.
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Affiliation(s)
- Dae Sik Yang
- Department of Radiation Oncology, Korea University Medical College, Seoul 02841, Korea; (D.S.Y.); (W.S.Y.)
- Department of Radiation Oncology, Korea University Guro Hospital, Seoul 08308, Korea
| | - Sunmin Park
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan 15355, Korea;
| | - Chai Hong Rim
- Department of Radiation Oncology, Korea University Medical College, Seoul 02841, Korea; (D.S.Y.); (W.S.Y.)
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan 15355, Korea;
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Medical College, Seoul 02841, Korea; (D.S.Y.); (W.S.Y.)
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan 15355, Korea;
| | - In-Soo Shin
- Graduate School of Education, AI Convergence Education, Dongguk University, Seoul 04620, Korea;
| | - Han Ah Lee
- Department of Gastroenterology, Anam Hospital, Korea University Medical College, Seoul 02841, Korea;
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Hong D, Zhou Y, Wan X, Su H, Shao H. Brachytherapy with Iodine-125 seeds for treatment of portal vein-branch tumor thrombus in patients with hepatocellular carcinoma. BMC Cancer 2021; 21:1020. [PMID: 34521375 PMCID: PMC8439081 DOI: 10.1186/s12885-021-08680-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/13/2021] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND There is currently no widely-accepted consensus for the management of hepatocellular carcinoma with portal vein tumor thrombus. We evaluate the safety and efficacy of ultrasound-guided percutaneous brachytherapy with iodine-125 seeds for the treatment of hepatocellular carcinoma with portal vein-branch tumor thrombus (PVBTT). METHODS Sixty-nine hepatocellular carcinoma patients with PVBTT were enrolled; 34 received transarterial chemoembolization (TACE) combined with iodine-125 seeds implanted in the PVBTT; 35 were treated with TACE alone. Adverse events, objective response rate, disease control rate, progression-free survival, and overall survival were compared between the two groups. Tumor responses of PVBTT and intrahepatic tumor were correlated. Multivariate and subgroup analyses were conducted for overall survival. RESULTS No grade 3 or 4 adverse events were recorded, and there was no difference in grade 1 or 2 adverse events between the two groups. Objective response rate and disease control rate for PVBTT were 58.9 and 91.2%, respectively, in the combined treatment group, which were significantly greater than the 5.7 and 54.3% rates, respectively, in the TACE-alone group (both p's ≤ 0.001). Intrahepatic tumor response was positively correlated with the PVBTT response (γ = 0.782, p < 0.01). Survival outcomes were better in the combined treatment group than in the TACE-alone group: the median progression-free survival for PVBTT was 9 months versus 3 months (HR = 0.187 [95% CI: 0.101, 0.345], p < 0.001), and the median overall survival was 11 months versus 7 months (HR = 0.448 [95% CI: 0.265, 0.758], p = 0.003). Multivariate analysis revealed that application of brachytherapy and lower grade PVBTT (Vp1 + Vp2 vs. Vp3) were protective predictors of overall survival. In stratified analysis, the benefit of overall survival was more significant in the subgroup of PVBTT Vp1 + Vp2 rather than in Vp3. CONCLUSIONS The combination of iodine-125 seed brachytherapy guided by ultrasound and TACE is a convenient, safe, and effective treatment for patients with HCC and PVBTT, conferring a better survival benefit than TACE alone.
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Affiliation(s)
- Duo Hong
- Department of Interventional Radiology, The First Hospital of China Medical University, No.155 Nanjing Road, Heping District, Shenyang, 110000 Liaoning China
| | - Yi Zhou
- Vascular Surgery and Interventional Department, Changzhou No.2 People’s Hospital, 29 Xinglong Lane, Tianning District, Changzhou, 213000 Jiangsu China
| | - Xiaoting Wan
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000 China
| | - Hongying Su
- Department of Interventional Radiology, The First Hospital of China Medical University, No.155 Nanjing Road, Heping District, Shenyang, 110000 Liaoning China
| | - Haibo Shao
- Department of Interventional Radiology, The First Hospital of China Medical University, No.155 Nanjing Road, Heping District, Shenyang, 110000 Liaoning China
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Jiang C, Jing S, Zhou H, Li A, Qiu X, Zhu X, Shen Z. Efficacy and Prognostic Factors of Trans-Arterial Chemoembolization Combined With Stereotactic Body Radiation Therapy for BCLC Stage B Hepatocellular Carcinoma. Front Oncol 2021; 11:640461. [PMID: 34336647 PMCID: PMC8322689 DOI: 10.3389/fonc.2021.640461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/01/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose This study aimed to evaluate the efficacy and safety of trans-arterial chemoembolization (TACE) followed by stereotactic body radiation therapy (SBRT) in treating Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) not amenable to resection and radiofrequency ablation (RFA). Methods From February 2012 to January 2017, a total of 57 BCLC stage B HCC patients who were unsuitable candidates for resection and RFA treated with TACE combined with CyberKnife SBRT were included in this retrospective study. Patients underwent TACE for a median of two times (1-5 times) before SBRT. SBRT prescription doses ranged from 30 Gy to 50 Gy in 3-5 fractions. Results The median follow-up time was 42 months. The objective response rate (CR + PR) was 85.9%, and the disease control rate (CR + PR + SD) was 96.5%. The local control (LC) rates were 91.1% and 84.3% at 1 and 2 years, respectively. The 1-, 2-, 3-year overall survival (OS) and the median survival time were 73.2%, 51.4%, 32.4% and 26.6 months, respectively. The 1-, 2-, and 3-year progression-free survival (PFS) were 34.2%, 21.6%, and 9%, respectively, with a median PFS time of 9.7 months. A subgroup analysis was conducted in 32 patients with AFP ≥ 200 ng/ml before TACE. OS was significantly prolonged in those with AFP that decreased by more than 75% than those with AFP that decreased by less than 75% (P = 0.018) after SBRT. The treatment was well tolerated with only one patient (1.8%) developed grade 3 gastrointestinal toxicity, and another patient developed non-classical RILD. In multivariate analysis, tumor length ≥ 10 cm and AFP ≥ 200 ng/ml were independent poor prognostic factors for OS. Conclusion The combination of TACE and Cyberknife SBRT showed optimal efficacy with acceptable toxicity for BCLC stage B HCC.
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Affiliation(s)
- Changchen Jiang
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shenghua Jing
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Han Zhou
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Aomei Li
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiangnan Qiu
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xixu Zhu
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zetian Shen
- Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Seidensticker M, Schütte K, Seidensticker R, Mühlmann M, Schulz C. Multi-modal and sequential treatment of liver cancer and its impact on the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2020; 48-49:101709. [PMID: 33317790 DOI: 10.1016/j.bpg.2020.101709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 01/31/2023]
Abstract
Hepatic tumors include hepatocellular cancer (HCC) and cholangiocarcinoma (CC), a small subgroup of tumors (approx. 1%) are classified as combined hepatocellularcholangiocellular carcinomas. Different stage-dependent therapeutic approaches comprise resection, local ablative techniques, locoregional therapies, systemic treatment, liver transplantation in selected cases and possible combination of these treatment modalities. This review summarizes current knowledge on multi-modal treatment strategies for liver cancer focusing on gastrointestinal side effects.
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Affiliation(s)
- Max Seidensticker
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany.
| | - Kerstin Schütte
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken, Marienhospital, Osnabrück, Germany
| | - Ricarda Seidensticker
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Marc Mühlmann
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Christian Schulz
- Medical Department II, University Hospital, LMU, Munich, Germany
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Park S, Yoon WS, Jang MH, Rim CH. Clinical efficacy of external beam radiotherapy complementing incomplete transarterial chemoembolization for hepatocellular carcinoma. Int J Radiat Biol 2020; 96:1541-1549. [PMID: 32990486 DOI: 10.1080/09553002.2020.1830316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE External beam radiotherapy (EBRT) has been commonly applied as salvage or a combination locoregional modality after transarterial chemoembolization (TACE) for hepatocellular carcinomas (HCCs). This study reports oncologic outcomes and feasibility after application of the two modalities in our center. METHODS Forty consecutive patients who underwent EBRT due to incomplete responses of TACE were evaluated. Fourteen patients (35.0%) received stereotactic body radiotherapy (SBRT) and the remaining patients received conventionally fractionated radiotherapy (RT). A majority of patients who underwent SBRT received doses of 27 to 48 Gy in 3-4 fractions [median EQD2 (Equivalent dose in 2 Gy per fraction radiotherapy): 57.0 Gy]. Conventionally fractionated RT was performed with a median EQD2 of 47.8 Gy. RESULTS The median follow-up duration was 14.4 months (range: 2.6-83.0 months). A majority (77.5%) of patients were regarded as having Child-Pugh grade A. The median tumor size was 3.4 cm (range: 0.8-20.1 cm). Ten patients (25.0%) had thrombosis at a main portal branch. The 1- and 2-year overall survival (OS) and progression-free survival (PFS) rates were 82.2% and 42.1% and 55.8% and 32.1%, respectively. The local control rates were 89.1% and 89.1% at 1 and 2 years, respectively. The albumin level was a significant factor affecting OS (p = .002), and the BCLC stage significantly affected PFS (p = .001). Intrahepatic, out-of-field recurrence was the main cause of disease progression (60.0%), and distant metastasis developed in 12 patients (30.0%) during follow-up. Non-classic radiation-induced liver disease was seen in five (12.5%) patients, and two (5%) patients experienced grade ≥3 hepatic toxicities. CONCLUSIONS EBRT after incomplete TACE was feasible and yielded favorable oncologic outcomes. However, disease progression related to intrahepatic failure remained a hindrance.
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Affiliation(s)
- Sunmin Park
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Gyeong-Gi Do, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Gyeong-Gi Do, Republic of Korea
| | - Mi Hee Jang
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Gyeong-Gi Do, Republic of Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Gyeong-Gi Do, Republic of Korea
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Mei J, Li S, Wang Q, Zhong X, Lu L, Kan A, Wei W, Guo R. A novel treatment strategy using indocyanine green for transarterial chemoembolization in BCLC stage C hepatocellular carcinoma. Cancer Med 2020; 9:62-76. [PMID: 31701652 PMCID: PMC6943082 DOI: 10.1002/cam4.2671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of our study was to propose a strategy based on indocyanine green (ICG) (SBI) to provide better clinical guidelines for transarterial chemoembolization (TACE) treatments for Barcelona clinic liver cancer (BCLC) stage C hepatocellular carcinoma (HCC) patients. MATERIALS AND METHODS From October 2005 to December 2012, 112 BCLC stage C HCC patients initially treated with TACE were investigated, randomly divided into a training cohort (n = 79) and validation cohort (n = 33). In training group, the patients were grouped based on their 15 minutes ICG retention rate (ICG R15), different chemo drugs and dose of lipidol in TACE. Overall survival (OS) and progression-free survival (PFS) were analyzed in subgroups. Strategy based on ICG was built and verified in validation group. RESULTS For those patients with ICG R15 values >10%, the lipiodol ≤10 mL group showed better survival than the lipiodol >10 mL group. For those patients with ICG R15 values ≤10%, the group that received triple-drug chemotherapy treatments with lipiodol diameter ratio values between 1 and 3 showed better survival than the other group. Patients who conformed with the SBI had better survival times than those who did not conform with the SBI, in both the training cohort (median OS 10.3 vs 5.1 months; P < .001; median PFS, 3.3 vs 2.1 months; P = .006) and the validation cohort (median OS 8.9 vs 7.1 months; P = .087; median PFS, 6.6 vs 2.3 months; P < .001). CONCLUSIONS The SBI is suitable and may provide survival benefits for TACE treatments in BCLC stage C HCC patients.
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Affiliation(s)
- Jie Mei
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
| | - Shao‐Hua Li
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
| | - Qiao‐Xuan Wang
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
- Department of Radiation Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
| | - Xiao‐Ping Zhong
- Department of Burn and Plastic Surgery2nd Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Liang‐He Lu
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
| | - Anna Kan
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
| | - Wei Wei
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
| | - Rong‐Ping Guo
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
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Stereotactic body radiotherapy in patients with hepatocellular carcinoma in a multimodal treatment setting. Strahlenther Onkol 2019; 196:334-348. [DOI: 10.1007/s00066-019-01540-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/23/2019] [Indexed: 12/24/2022]
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Komatsu S, Kido M, Tanaka M, Kuramitsu K, Tsugawa D, Awazu M, Gon H, Toyama H, Ueno K, Fukumoto T. Clinical Relevance of Reductive Hepatectomy for Barcelona Clinic Liver Cancer Stages B and C Advanced Hepatocellular Carcinoma: A Single-Center Experience of 102 Patients. World J Surg 2019; 43:2571-2578. [PMID: 31222640 DOI: 10.1007/s00268-019-05052-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND This study aimed to evaluate the clinical relevance of hepatectomy for Barcelona Clinic Liver Cancer (BCLC) stages B and C advanced hepatocellular carcinoma (HCC). METHODS A total of 314 patients (149 and 165 BCLC stages B and C, respectively) who underwent hepatectomy were included. Complete hepatectomy (without residual tumors after hepatectomy) and reductive hepatectomy (apparent residual tumors after hepatectomy) were performed for 212 and 102 patients, respectively. Short-term operative and postoperative outcomes, as well as long-term outcomes, were evaluated. RESULTS The median survival times of patients with stage B disease undergoing complete hepatectomy and reductive hepatectomy were 48.9 and 20.1 months, respectively (p = 0.0075), whereas those of patients with stage C disease were 19.5 and 17.6 months, respectively (p = 0.0140). The 3-year overall survival rates of patients with stage B disease undergoing reductive hepatectomy with and without subsequent local treatments after surgery were 47.5% and 0%, respectively, whereas those of patients with stage C diseases were 18.6% and 0%, respectively. CONCLUSIONS Survival benefits are obvious for both BCLC stages B and C HCC when complete hepatectomy can be performed safely. Reductive hepatectomy is also acceptable for BCLC stages B and C when subsequent local treatment for remnant liver tumors can be performed safely after reductive hepatectomy. Without subsequent local treatment, reductive hepatectomy has little clinical relevance. Thus, a cautious approach to patient selection is required for this aggressive strategy.
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Affiliation(s)
- Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan.
| | - Masahiro Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Motofumi Tanaka
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Kaori Kuramitsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Daisuke Tsugawa
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Masahide Awazu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Hidetoshi Gon
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Kimihiko Ueno
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
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Wu M, Gao S, Song H, Zhang Z, Zheng Z, Yan Z, Wang X, Wang J, Liu L. Percutaneous microwave ablation combined with simultaneous transarterial chemoembolization for hepatocellular carcinoma with macrovascular invasion or extrahepatic metastases. J Interv Med 2019; 2:55-59. [PMID: 34805873 PMCID: PMC8562208 DOI: 10.1016/j.jimed.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the safety and efficacy of percutaneous microwave ablation (MWA) combined with simultaneous transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) or extrahepatic metastases (EHM). Methods Between August 2012 and April 2017, 101 patients with MVI/EHM of HCC underwent percutaneous MWA combined with simultaneous TACE at our center. The clinical data were collected and analyzed for survival and prognostic factors. Results The mean follow-up time was 23.6 ± 14.7 months. One patient had grade 3 complications, and the median overall survival was 12.0 months (95% confidence interval 9.7–14.3). Multivariate analysis showed that Child-Pugh class, serum alpha-fetoprotein level, and Eastern Cooperative Oncology Group performance status were independent factors of survival. Conclusion Our results suggest that percutaneous MWA combined with simultaneous TACE is a safe and effective treatment for HCC with MVI/EHM.
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Affiliation(s)
- Mengfei Wu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shanshan Gao
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Huadan Song
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zihan Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhiyuan Zheng
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Xiaolin Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Jianhua Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Corresponding author. Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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