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Abdelmalak J, Lubel JS, Sinclair M, Majeed A, Kemp W, Roberts SK. Quality of care in hepatocellular carcinoma-A critical review. Hepatol Commun 2025; 9:e0595. [PMID: 39665645 PMCID: PMC11637749 DOI: 10.1097/hc9.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 10/16/2024] [Indexed: 12/13/2024] Open
Abstract
There is significant variation in HCC management across different centers with poor adherence to evidence-based clinical practice guidelines as assessed in prior studies. In Australia, quality indicators (QIs) have recently been proposed by a multidisciplinary group of experts to help provide a framework to assess and monitor the quality of HCC care. In this review, we discuss the many areas where real-world practice deviates from evidence-based medicine, the role that QI sets play in addressing this gap, and the similarities and differences between Australian QIs and other leading treatment guidelines and QI sets from around the world. We focus on the utility of QI sets to identify opportunities for targeted improvement in the real-world clinical environment. We conclude with a discussion about the formation of a national clinical quality registry as a long-term measure to facilitate continual improvements in patient care within and across sites in order to optimize patient outcomes.
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Affiliation(s)
- Jonathan Abdelmalak
- Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - John S. Lubel
- Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Marie Sinclair
- Victorian Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stuart K. Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
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2
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Mak LY, Liu K, Chirapongsathorn S, Yew KC, Tamaki N, Rajaram RB, Panlilio MT, Lui R, Lee HW, Lai JCT, Kulkarni AV, Premkumar M, Lesmana CRA, Hsu YC, Huang DQ. Liver diseases and hepatocellular carcinoma in the Asia-Pacific region: burden, trends, challenges and future directions. Nat Rev Gastroenterol Hepatol 2024; 21:834-851. [PMID: 39147893 DOI: 10.1038/s41575-024-00967-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/17/2024]
Abstract
Globally, nearly half of deaths from cirrhosis and chronic liver diseases (CLD) and three-quarters of deaths from hepatocellular carcinoma (HCC) occur in the Asia-Pacific region. Chronic hepatitis B is responsible for the vast majority of liver-related deaths in the region. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common form of CLD, affecting an estimated 30% of the adult population. Compared with people of European descent, people from the Asia-Pacific region carry more genetic variants associated with MASLD and its progression. Alcohol is a fast-growing cause of CLD and HCC in Asia as a result of the rising per-capita consumption of alcohol. Drug-induced liver injury is under-recognized and probably has a high prevalence in this region. The epidemiological and outcome data of acute-on-chronic liver failure are heterogeneous, and non-unified definitions across regions contribute to this heterogeneity. CLDs are severely underdiagnosed, and effective treatments and vaccinations are underutilized. In this Review, we highlight trends in the burden of CLD and HCC in the Asia-Pacific region and discuss the rapidly changing aetiologies of liver disease. We examine the multiple gaps in the care cascade and propose mitigating strategies and future directions.
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Affiliation(s)
- Lung-Yi Mak
- The University of Hong Kong, Hong Kong, China
| | - Ken Liu
- The University of Sydney, Sydney, Australia
| | | | | | | | | | | | - Rashid Lui
- The Chinese University of Hong Kong, Hong Kong, China
| | - Hye Won Lee
- Yonsei University College of Medicine, Seoul, Korea
| | | | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Yao Chun Hsu
- Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine and Graduate Institute of Medicine, I-Shou University, Kaohsiung, Taiwan
- School of Medicine and Graduate Institute of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.
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3
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Cai L, Du Y, Xiong H, Zheng H. Application of nanotechnology in the treatment of hepatocellular carcinoma. Front Pharmacol 2024; 15:1438819. [PMID: 39679376 PMCID: PMC11637861 DOI: 10.3389/fphar.2024.1438819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 11/19/2024] [Indexed: 12/17/2024] Open
Abstract
Hepatocellular carcinoma is the predominant histologic variant of hepatic malignancy and has become a major challenge to global health. The increasing incidence and mortality of hepatocellular carcinoma has created an urgent need for effective prevention, diagnosis, and treatment strategies. This is despite the impressive results of multiple treatments in the clinic. However, the unique tumor immunosuppressive microenvironment of hepatocellular carcinoma increases the difficulty of treatment and immune tolerance. In recent years, the application of nanoparticles in the treatment of hepatocellular carcinoma has brought new hope for tumor patients. Nano agents target tumor-associated fibroblasts, regulatory T cells, myeloid suppressor cells, tumor-associated macrophages, tumor-associated neutrophils, and immature dendritic cells, reversed the immunosuppressive microenvironment of hepatocellular carcinoma. In addition, he purpose of this review is to summarize the advantages of nanotechnology in guiding surgical excision, local ablation, TACE, standard chemotherapy, and immunotherapy, application of nano-vaccines has also continuously enriched the treatment of liver cancer. This study aims to investigate the potential applications of nanotechnology in the management of hepatocellular carcinoma, with the ultimate goal of enhancing therapeutic outcomes and improving the prognosis for patients affected by this malignancy.
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Affiliation(s)
| | | | | | - Honggang Zheng
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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4
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Liu S, Quan Z, Liang J, Wang F, Yan H, Wang Z, Tang B, Qin X. LINC02466 promotes the progression of hepatocellular carcinoma through the mTOR pathway. Discov Oncol 2024; 15:623. [PMID: 39503938 PMCID: PMC11541976 DOI: 10.1007/s12672-024-00999-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/26/2024] [Indexed: 11/09/2024] Open
Abstract
OBJECTIVE Long non-coding RNAs (lncRNAs) LINC02466 is an lncRNA newly linked to the adverse outcomes in primary liver cancer patients, and its crucial involvement in the disease's escalation. Decoding the specific role of LINC02466 in HCC progression is of great significance to provide a potential therapeutic target for HCC. METHODS RT-qPCR and Western Blot techniques was used to analyze the expression levels of LINC02466 in both malignant and surrounding healthy liver tissues. CCK8 assays and colony formation experiments indicates the LINC02466's effect on the proliferation rates of liver cancer cells. Flow cytometry was pivotal in revealing its significant influence on the cell cycle of these cells. Kaplan-Meier survival analysis with log-rank tests were employed. RESULTS The suppression of LINC02466 markedly reduces the stemness attributes of liver cancer cells, indicating a potential therapeutic target. LINC02466 overexpression significantly increased tumor growth rates and final volumes. Further research indicated that LINC02466 significantly influences liver cancer progression through regulating the mTOR signaling pathway. CONCLUSION LINC02466 regulating cell proliferation, the cell cycle, and stemness characteristics via the mTOR pathway, suggesting LINC02466 as a potential therapeutic target for primary liver cancer.
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Affiliation(s)
- Shiqian Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Zhipeng Quan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Jiaming Liang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Fuqiang Wang
- Department of Gastrointestinal Surgery and Hepatobiliary Surgery and Department of Critical Care Medicine, Guilin Medical University, Affiliated Hospital, Guilin, 541001, Guangxi, People's Republic of China
| | - Hao Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Zhenran Wang
- Department of Gastrointestinal Surgery and Hepatobiliary Surgery and Department of Critical Care Medicine, Guilin Medical University, Affiliated Hospital, Guilin, 541001, Guangxi, People's Republic of China.
| | - Bo Tang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Xuebin Qin
- Department of Gastrointestinal Surgery and Hepatobiliary Surgery and Department of Critical Care Medicine, Guilin Medical University, Affiliated Hospital, Guilin, 541001, Guangxi, People's Republic of China.
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5
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den Toom W, Negenman EM, Willemssen FE, van Werkhoven E, Porte RJ, de Wilde RF, Sprengers D, Antonisse IE, Heijmen BJ, Méndez Romero A. Long-term outcomes of more than a decade treating patients with stereotactic body radiation therapy for hepatocellular carcinoma. Clin Transl Radiat Oncol 2024; 49:100878. [PMID: 39512948 PMCID: PMC11541668 DOI: 10.1016/j.ctro.2024.100878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 10/09/2024] [Accepted: 10/14/2024] [Indexed: 11/15/2024] Open
Abstract
Purpose/Objectives To evaluate if stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) has a durable effect on tumor control and can be delivered safely. Materials/Methods Patients included in this retrospective study have been treated at our institution from January 2008 to December 2022. Eligibility criteria were diagnosis of HCC, BCLC stage 0-A-B, non-cirrhotic liver or liver with cirrhosis Child-Pugh class A, and a maximum of three lesions with a cumulative diameter of ≤ 6 cm. Patients with relapses after surgery, thermal ablation or TACE or patients awaiting transplant were also candidates for SBRT. SBRT was delivered in 6 fractions of 8 or 9 Gy. The primary endpoint was local (target) control (LC). Secondary endpoints were time to progression (TTP), overall survival (OS), response rate (RR) and toxicity. Results A total of 52 patients received SBRT at our institution and 51 were included in this study. One patient objected and was excluded. Median follow-up was 2.1 years for LC and 2.3 years for OS. Median tumor size was 26 mm. LC rates at 1, 2, and 5 years were 100 %, 95 % and 95 % respectively. Median TTP was 45.6 months. Median OS was 7.1 years. RR was 96 %. No patients in this study have experienced SBRT related CTC AE grade ≥ 3 toxicity. Conclusion SBRT resulted in excellent long-term local control rates and absence of severe toxicity in a group of HCC patients. The reported outcomes compare favorably with other local therapies. SBRT should be considered as one of the available local treatment options for HCC.
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Affiliation(s)
- Wilhelm den Toom
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eva M. Negenman
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Francois E.J.A. Willemssen
- Departments of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Erik van Werkhoven
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert J. Porte
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Roeland F. de Wilde
- Erasmus MC Transplant Institute, Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dave Sprengers
- Department of Gastroenterology & Hepatology, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Imogeen E. Antonisse
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ben J.M. Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alejandra Méndez Romero
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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6
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Verstappen D, Pasquier D, Chen Y, Lambin P, Woodruff HC. Radiomic feature robustness in CT scans affected by fiducial marker induced streak artifacts for patients with hepatocellular carcinoma. Med Phys 2024; 51:8362-8370. [PMID: 39047166 DOI: 10.1002/mp.17329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Stereotactic body radiation therapy for hepatocellular carcinoma necessitates the implantation of gold fiducial markers in the liver, resulting in artifacts on computed tomography (CT) scans, which affect radiomic feature values. PURPOSE This report aims to assess the effect of these artifacts on radiomic features and how removing CT slices affects radiomic features extracted from 3D regions of interest (ROI). METHODS First, the range variation in 38 tumor contours unaffected by artifacts was assessed after sequentially and randomly removing 25%, 50%, 75% of slices. Subsequently, the agreement of feature values before and after removing ROI slices containing artifacts from 186 patients' CT scans was assessed with Lin's concordance correlation coefficient (CCC) and a Wilcoxon signed-rank test. RESULTS In artifact-free tumor volumes, at least 71% of features remain robust with up to 50% of slices removed, while 56% remains robust with up to 75% of slices removed. When comparing contours before and after removing slices containing artifacts, around a third of features in the tumor contour and surrounding area remain robust (CCC > 0.9), compared to 44% in the healthy liver. Concerning the tumor, 13% (Gray Level Size Zone Matrix) to 61% (first order) of the features remain robust (CCC > 0.9). Over 90% of features differ significantly as assessed by Wilcoxon signed-rank test, however. CONCLUSIONS This study demonstrates that removing slices containing artifacts is a feasible solution for the CT fiducial problem in this patient population and provides insight into which features are affected.
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Affiliation(s)
- Damon Verstappen
- The D-Lab, Department of Precision Medicine, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - David Pasquier
- The D-Lab, Department of Precision Medicine, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
- CNRS, Centrale Lille, UMR 9189 - CRIStAL, Univ. Lille, Lille, France
| | - Yi Chen
- The D-Lab, Department of Precision Medicine, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Phillipe Lambin
- The D-Lab, Department of Precision Medicine, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Henry C Woodruff
- The D-Lab, Department of Precision Medicine, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
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7
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Aslam A, Chernyak V, Miller FH, Bashir M, Do R, Sirlin C, Lewandowski RJ, Kim CY, Kielar AZ, Kambadakone AR, Yarmohammadi H, Kim E, Owen D, Charalel RA, Shenoy-Bhangle A, Burke LM, Mendiratta-Lala M, Atzen S. CT/MRI LI-RADS 2024 Update: Treatment Response Assessment. Radiology 2024; 313:e232408. [PMID: 39530896 PMCID: PMC11605109 DOI: 10.1148/radiol.232408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 05/28/2024] [Accepted: 07/17/2024] [Indexed: 11/16/2024]
Abstract
With the rising incidence of hepatocellular carcinoma, there has been increasing use of local-regional therapy (LRT) to downstage or bridge to transplant, for definitive treatment, and for palliation. The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Assessment (TRA) algorithm provides guidance for step-by-step tumor assessment after LRT and standardized reporting. Current evidence suggests that the algorithm performs well in the assessment of tumor response to arterial embolic and loco-ablative therapies and fair when assessing response to radiation-based therapies, with limited data to validate the latter. Both evidence-based and expert-based refinements of the algorithm are needed to improve its diagnostic accuracy after varying types of LRT. This review provides an overview of the challenges and limitations of the LI-RADS TRA algorithm version 2017 and discusses the refinements introduced in the updated 2024 LI-RADS algorithm for CT/MRI.
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Affiliation(s)
- Anum Aslam
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Victoria Chernyak
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Frank H. Miller
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Mustafa Bashir
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Richard Do
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Claude Sirlin
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Robert J. Lewandowski
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Charles Y. Kim
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Ania Zofia Kielar
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Avinash R. Kambadakone
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Hooman Yarmohammadi
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Edward Kim
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Dawn Owen
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Resmi A. Charalel
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Anuradha Shenoy-Bhangle
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Lauren M. Burke
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Mishal Mendiratta-Lala
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
| | - Sarah Atzen
- From the Department of Radiology, University of Michigan Health
System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030 (A.A., M.M.L.);
Department of Radiology, Memorial Sloan Kettering Medical Center, New York, NY
(V.C., R.D., H.Y.); Department of Radiology, Northwestern Medical Center,
Chicago, Ill (F.H.M., R.J.L.); Department of Radiology, Duke University Medical
Center, Durham, NC (M.B.); Department of Radiology, University of California San
Diego, San Diego, Calif (C.S., C.Y.K.); Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (A.R.K., A.S.B.); Department of
Radiology, Mount Sinai Medical Center, New York, NY (E.K.); Department of
Radiology, Mayo Clinic Rochester, Rochester, Minn (D.O.); Department of
Radiology, Weill Cornell Medical Center, New York, NY (R.A.C.); and Department
of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
(L.M.B.)
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8
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Yang Z, Liu S, Hu L, Chen J, Wang J, Pan Y, Xu L, Liu M, Chen M, Xi M, Zhang Y. Stereotactic body radiotherapy is an alternative to radiofrequency ablation for single HCC ≤5.0 cm. JHEP Rep 2024; 6:101151. [PMID: 39308987 PMCID: PMC11416668 DOI: 10.1016/j.jhepr.2024.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/28/2024] [Accepted: 06/19/2024] [Indexed: 09/25/2024] Open
Abstract
Background & Aims Radiation therapy has been refined with increasing evidence of the benefits of stereotactic body radiation therapy (SBRT) in treating hepatocellular carcinoma (HCC). In this study, we aimed to evaluate whether SBRT could serve as an alternative to radiofrequency ablation (RFA) for small HCC with a single lesion ≤5.0 cm. Methods Patients with a single HCC lesion ≤5.0 cm who received RFA or SBRT were included. Cumulative local/distant recurrence rate, progression-free survival, overall survival, adverse events and subsequent treatments after recurrence were analyzed. Results A total of 288 patients receiving RFA (n = 166) or SBRT (n = 122) were enrolled. The baseline characteristics between the two groups were comparable. The cumulative local recurrence rate in the SBRT group was significantly lower than that in the RFA group (hazard ratio [HR] 0.30, 95% CI 0.16-0.57, p <0.001), especially for patients with tumours >2.0 cm (HR 0.20, 95% CI 0.08-0.50, p <0.001) or adjacent to major vessels (HR 0.29, 95% CI 0.13-0.66, p <0.001). Cumulative distant recurrence rate, progression-free survival and overall survival were not significantly different between the two groups (all p >0.050). Adverse events were mild and easily reversible. However, more patients in the SBRT group suffered from Child-Pugh score and total bilirubin increases. More treatment options after recurrence or progression might be available for patients in the RFA group compared to those in the SBRT group (p <0.001). Conclusions Both RFA and SBRT were effective and safe for HCC with a single lesion ≤5.0 cm. SBRT could be an alternative treatment to RFA, especially for tumours >2.0 cm or adjacent to major vessels. Impact and implications Stereotactic body radiation therapy (SBRT) may be used as an alternative treatment to thermal ablation for patients with BCLC stage A hepatocellular carcinoma (HCC) who are not candidates for surgical resection, including those with tumours >3 cm and those with 1 to 3 tumours. This study focused on HCC patients with a specific tumour burden, namely a single lesion ≤5.0 cm, demonstrating that SBRT could be an effective and safe alternative to radiofrequency ablation (RFA), especially for those with tumours >2.0 cm or adjacent to major vessels. The findings of this study provided robust empirical evidence supporting the utilization of SBRT in treating small HCC, while also establishing a solid foundation for future prospective clinical investigations.
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Affiliation(s)
- Zhoutian Yang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Shiliang Liu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Li Hu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Jinbin Chen
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Juncheng Wang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Yangxun Pan
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Li Xu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Mengzhong Liu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Minshan Chen
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Mian Xi
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
| | - Yaojun Zhang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China
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9
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Lu SL, Pei Y, Liu WW, Han K, Cheng JCH, Li PC. Evaluating ECM stiffness and liver cancer radiation response via shear-wave elasticity in 3D culture models. Radiat Oncol 2024; 19:128. [PMID: 39334323 PMCID: PMC11430210 DOI: 10.1186/s13014-024-02513-7] [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: 12/16/2023] [Accepted: 08/26/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The stiffness of the tumor microenvironment (TME) directly influences cellular behaviors. Radiotherapy (RT) is a common treatment for solid tumors, but the TME can impact its efficacy. In the case of liver cancer, clinical observations have shown that tumors within a cirrhotic, stiffer background respond less to RT, suggesting that the extracellular matrix (ECM) stiffness plays a critical role in the development of radioresistance. METHODS This study explored the effects of ECM stiffness and the inhibition of lysyl oxidase (LOX) isoenzymes on the radiation response of liver cancer in a millimeter-sized three-dimensional (3D) culture. We constructed a cube-shaped ECM-based millimeter-sized hydrogel containing Huh7 human liver cancer cells. By modulating the collagen concentration, we produced two groups of samples with different ECM stiffnesses to mimic the clinical scenarios of normal and cirrhotic livers. We used a single-transducer system for shear-wave-based elasticity measurement, to derive Young's modulus of the 3D cell culture to investigate how the ECM stiffness affects radiosensitivity. This is the first demonstration of a workflow for assessing radiation-induced response in a millimeter-sized 3D culture. RESULTS Increased ECM stiffness was associated with a decreased radiation response. Moreover, sonoporation-assisted LOX inhibition with BAPN (β-aminopropionitrile monofumarate) significantly decreased the initial ECM stiffness and increased RT-induced cell death. Inhibition of LOX was particularly effective in reducing ECM stiffness in stiffer matrices. Combining LOX inhibition with RT markedly increased radiation-induced DNA damage in cirrhotic liver cancer cells, enhancing their response to radiation. Furthermore, LOX inhibition can be combined with sonoporation to overcome stiffness-related radioresistance, potentially leading to better treatment outcomes for patients with liver cancer. CONCLUSIONS The findings underscore the significant influence of ECM stiffness on liver cancer's response to radiation. Sonoporation-aided LOX inhibition emerges as a promising strategy to mitigate stiffness-related resistance, offering potential improvements in liver cancer treatment outcomes.
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Affiliation(s)
- Shao-Lun Lu
- Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu Pei
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Wei-Wen Liu
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Graduate of Institute of Oral Biology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kun Han
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Jason Chia-Hsien Cheng
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Radiation Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Pai-Chi Li
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan.
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10
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Saha B, Pallatt S, Banerjee A, Banerjee AG, Pathak R, Pathak S. Current Insights into Molecular Mechanisms and Potential Biomarkers for Treating Radiation-Induced Liver Damage. Cells 2024; 13:1560. [PMID: 39329744 PMCID: PMC11429644 DOI: 10.3390/cells13181560] [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: 08/07/2024] [Revised: 09/10/2024] [Accepted: 09/11/2024] [Indexed: 09/28/2024] Open
Abstract
Highly conformal delivery of radiation therapy (RT) has revolutionized the treatment landscape for primary and metastatic liver cancers, yet concerns persist regarding radiation-induced liver disease (RILD). Despite advancements, RILD remains a major dose-limiting factor due to the potential damage to normal liver tissues by therapeutic radiation. The toxicity to normal liver tissues is associated with a multitude of physiological and pathological consequences. RILD unfolds as multifaceted processes, intricately linking various responses, such as DNA damage, oxidative stress, inflammation, cellular senescence, fibrosis, and immune reactions, through multiple signaling pathways. The DNA damage caused by ionizing radiation (IR) is a major contributor to the pathogenesis of RILD. Moreover, current treatment options for RILD are limited, with no established biomarker for early detection. RILD diagnosis often occurs at advanced stages, highlighting the critical need for early biomarkers to adjust treatment strategies and prevent liver failure. This review provides an outline of the diverse molecular and cellular mechanisms responsible for the development of RILD and points out all of the available biomarkers for early detection with the aim of helping clinicians decide on advance treatment strategies from a single literature recourse.
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Affiliation(s)
- Biki Saha
- Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai 603103, India
| | - Sneha Pallatt
- Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai 603103, India
| | - Antara Banerjee
- Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai 603103, India
| | - Abhijit G. Banerjee
- R&D, Genomic Bio-Medicine Research and Incubation (GBMRI), Durg 491001, Chhattisgarh, India
| | - Rupak Pathak
- Division of Radiation Health, Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Surajit Pathak
- Medical Biotechnology, Faculty of Allied Health Sciences, Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai 603103, India
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11
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Gerum S, Grambozov B, Roeder F. Stereotactic body radiation therapy (SBRT) in patients with hepatocellular cancer-a narrative review and expert opinion. J Gastrointest Oncol 2024; 15:1880-1892. [PMID: 39279965 PMCID: PMC11399857 DOI: 10.21037/jgo-23-771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/26/2023] [Indexed: 09/18/2024] Open
Abstract
Background and Objective Stereotactic body radiation therapy (SBRT) is a highly conformal technique of external beam radiotherapy precisely delivering high total (ablative) doses in a small number of fractions to clearly defined target volumes. Its development enabled efficient and safe radiation treatments in patients with localized hepatocellular cancer (HCC) unsuitable for other local treatment options. Moreover, it can be easily combined with several other therapy approaches. Thus, the aim of this narrative review is to outline the current role of SBRT in the multifocal treatment of HCC patients. Methods We searched PubMed for articles dealing with SBRT alone, in combination with other local or systemic treatments or in comparison to other local treatments in patients with HCC. This included original articles, reviews and conceptional articles dealing with the technique of SBRT. All articles were analysed for suitability by two independent reviewers. Key Content and Findings This review summarizes the currently available evidence for SBRT as a definitive treatment for HCC as well as its role within combination approaches including bridging to transplantation. SBRT is an effective and safe definitive treatment option in patients with localized HCC unsuitable for surgery and/or other local therapies based on retrospective and prospective series. Its combination with other local treatments yields superior results compared to single modality treatment based on non-randomized data. A growing number of prospective trials confirmed at least similar if not superior rates of local control with low toxicities compared to well established other local treatments even in non-selected patients. Conclusions SBRT is a promising tool in the treatment of HCC. It can be used either as definitive treatment, within combination approaches or as a bridging tool. Several phase III trials comparing SBRT with other local options are ongoing, which will further clarify its encouraging role.
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Affiliation(s)
- Sabine Gerum
- Department of Radiotherapy and Radiation Oncology, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Brane Grambozov
- Department of Radiotherapy and Radiation Oncology, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Falk Roeder
- Department of Radiotherapy and Radiation Oncology, Paracelsus Medical University (PMU), Salzburg, Austria
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12
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Abdelmalak J, Strasser SI, Ngu NL, Dennis C, Sinclair M, Majumdar A, Collins K, Bateman K, Dev A, Abasszade JH, Valaydon Z, Saitta D, Gazelakis K, Byers S, Holmes J, Thompson AJ, Howell J, Pandiaraja D, Bollipo S, Sharma S, Joseph M, Sawhney R, Nicoll A, Batt N, Tang MJ, Riordan S, Hannah N, Haridy J, Sood S, Lam E, Greenhill E, Lubel J, Kemp W, Majeed A, Zalcberg J, Roberts SK. Initial Trans-Arterial Chemo-Embolisation (TACE) Is Associated with Similar Survival Outcomes as Compared to Upfront Percutaneous Ablation Allowing for Follow-Up Treatment in Those with Single Hepatocellular Carcinoma (HCC) ≤ 3 cm: Results of a Real-World Propensity-Matched Multi-Centre Australian Cohort Study. Cancers (Basel) 2024; 16:3010. [PMID: 39272868 PMCID: PMC11394053 DOI: 10.3390/cancers16173010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/24/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024] Open
Abstract
Percutaneous ablation is recommended in Barcelona Clinic Liver Cancer (BCLC) stage 0/A patients with HCC ≤3 cm as a curative treatment modality alongside surgical resection and liver transplantation. However, trans-arterial chemo-embolisation (TACE) is commonly used in the real-world as an initial treatment in patients with single small HCC in contrast to widely accepted clinical practice guidelines which typically describe TACE as a treatment for intermediate-stage HCC. We performed this real-world propensity-matched multi-centre cohort study in patients with single HCC ≤ 3 cm to assess for differences in survival outcomes between those undergoing initial TACE and those receiving upfront ablation. Patients with a new diagnosis of BCLC 0/A HCC with a single tumour ≤3 cm first diagnosed between 1 January 2016 and 31 December 2020 who received initial TACE or ablation were included in the study. A total of 348 patients were included in the study, with 147 patients receiving initial TACE and 201 patients undergoing upfront ablation. After propensity score matching using key covariates, 230 patients were available for analysis with 115 in each group. There were no significant differences in overall survival (log-rank test p = 0.652) or liver-related survival (log-rank test p = 0.495) over a median follow-up of 43 months. While rates of CR were superior after ablation compared to TACE as a first treatment (74% vs. 56%, p < 0.004), there was no significant difference in CR rates when allowing for further subsequent treatments (86% vs. 80% p = 0.219). In those who achieved CR, recurrence-free survival and local recurrence-free survival were similar (log rank test p = 0.355 and p = 0.390, respectively). Our study provides valuable real-world evidence that TACE when offered with appropriate follow-up treatment is a reasonable initial management strategy in very early/early-stage HCC, with similar survival outcomes as compared to those managed with upfront ablation. Further work is needed to better define the role for TACE in BCLC 0/A HCC.
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Affiliation(s)
- Jonathan Abdelmalak
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
- Department of Medicine, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Natalie L Ngu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Claude Dennis
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Marie Sinclair
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Avik Majumdar
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Kate Collins
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Katherine Bateman
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Anouk Dev
- Department of Gastroenterology, Monash Health, Clayton, VIC 3168, Australia
| | - Joshua H Abasszade
- Department of Gastroenterology, Monash Health, Clayton, VIC 3168, Australia
| | - Zina Valaydon
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia
| | - Daniel Saitta
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia
| | - Kathryn Gazelakis
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia
| | - Susan Byers
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia
| | - Jacinta Holmes
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville, VIC 3052, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville, VIC 3052, Australia
| | - Jessica Howell
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Department of Medicine, St. Vincent's Hospital Melbourne, University of Melbourne, Parkville, VIC 3052, Australia
| | - Dhivya Pandiaraja
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Suresh Sharma
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Merlyn Joseph
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia
- Department of Medicine, Eastern Health Clinical School, Box Hill, VIC 3128, Australia
| | - Amanda Nicoll
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia
- Department of Medicine, Eastern Health Clinical School, Box Hill, VIC 3128, Australia
| | - Nicholas Batt
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia
| | - Myo J Tang
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Stephen Riordan
- Department of Gastroenterology, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Nicholas Hannah
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - James Haridy
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Siddharth Sood
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| | - Eileen Lam
- Department of Medicine, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Elysia Greenhill
- Department of Medicine, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - John Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
- Department of Medicine, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
- Department of Medicine, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
- Department of Medicine, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Stuart K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia
- Department of Medicine, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia
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13
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Lai J, Luo Z, Liu J, Hu H, Jiang H, Liu P, He L, Cheng W, Ren W, Wu Y, Piao JG, Wu Z. Charged Gold Nanoparticles for Target Identification-Alignment and Automatic Segmentation of CT Image-Guided Adaptive Radiotherapy in Small Hepatocellular Carcinoma. NANO LETTERS 2024; 24:10614-10623. [PMID: 39046153 PMCID: PMC11363118 DOI: 10.1021/acs.nanolett.4c02823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 07/25/2024]
Abstract
Because of the challenges posed by anatomical uncertainties and the low resolution of plain computed tomography (CT) scans, implementing adaptive radiotherapy (ART) for small hepatocellular carcinoma (sHCC) using artificial intelligence (AI) faces obstacles in tumor identification-alignment and automatic segmentation. The current study aims to improve sHCC imaging for ART using a gold nanoparticle (Au NP)-based CT contrast agent to enhance AI-driven automated image processing. The synthesized charged Au NPs demonstrated notable in vitro aggregation, low cytotoxicity, and minimal organ toxicity. Over time, an in situ sHCC mouse model was established for in vivo CT imaging at multiple time points. The enhanced CT images processed using 3D U-Net and 3D Trans U-Net AI models demonstrated high geometric and dosimetric accuracy. Therefore, charged Au NPs enable accurate and automatic sHCC segmentation in CT images using classical AI models, potentially addressing the technical challenges related to tumor identification, alignment, and automatic segmentation in CT-guided online ART.
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Affiliation(s)
- Jianjun Lai
- Department
of Radiation Oncology, Zhejiang Hospital, Hangzhou 310013, China
- Instiute
of Intelligent Control and Robotics, Hangzhou
Dianzi University, Hangzhou 310018, China
| | - Zhizeng Luo
- Instiute
of Intelligent Control and Robotics, Hangzhou
Dianzi University, Hangzhou 310018, China
| | - Jiping Liu
- Department
of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Haili Hu
- Department
of Radiation Oncology, Zhejiang Hospital, Hangzhou 310013, China
| | - Hao Jiang
- Department
of Radiation Oncology, Zhejiang Hospital, Hangzhou 310013, China
| | - Pengyuan Liu
- Department
of Radiation Oncology, Zhejiang Hospital, Hangzhou 310013, China
| | - Li He
- School
of Pharmaceutical Sciences, Zhejiang Chinese
Medical University, Hangzhou 310053, China
| | - Weiyi Cheng
- School
of Pharmaceutical Sciences, Zhejiang Chinese
Medical University, Hangzhou 310053, China
| | - Weiye Ren
- School
of Pharmaceutical Sciences, Zhejiang Chinese
Medical University, Hangzhou 310053, China
| | - Yajun Wu
- Department
of Pharmacy, Zhejiang Hospital, Hangzhou 310013, China
| | - Ji-Gang Piao
- School
of Pharmaceutical Sciences, Zhejiang Chinese
Medical University, Hangzhou 310053, China
| | - Zhibing Wu
- Department
of Radiation Oncology, Zhejiang Hospital, Hangzhou 310013, China
- Department
of Radiation Oncology, Affiliated Zhejiang
Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
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14
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Saleh Y, Abu Hejleh T, Abdelrahim M, Shamseddine A, Chehade L, Alawabdeh T, Mohamad I, Sammour M, Turfa R. Hepatocellular Carcinoma: The Evolving Role of Systemic Therapies as a Bridging Treatment to Liver Transplantation. Cancers (Basel) 2024; 16:2081. [PMID: 38893200 PMCID: PMC11171314 DOI: 10.3390/cancers16112081] [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: 05/02/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths. Classically, liver transplantation (LT) can be curative for HCC tumors within the Milan criteria. Bridging strategies to reduce the dropouts from LT waiting lists and/or to downstage patients who are beyond the Milan criteria are widely utilized. We conducted a literature-based review to evaluate the role of systemic therapies as a bridging treatment to liver transplantation (LT) in HCC patients. Tyrosine kinase inhibitors (TKIs) can be used as a systemic bridging therapy to LT in patients with contraindications for locoregional liver-directed therapies. Immune checkpoint inhibitor (ICI) treatment can be utilized either as a monotherapy or as a combination therapy with bevacizumab or TKIs prior to LT. Acute rejection after liver transplantation is a concern in the context of ICI treatment. Thus, a safe ICI washout period before LT and cautious post-LT immunosuppression strategies are required to reduce post-LT rejections and to optimize clinical outcomes. Nevertheless, prospective clinical trials are needed to establish definitive conclusions about the utility of systemic therapy as a bridging modality prior to LT in HCC patients.
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Affiliation(s)
- Yacob Saleh
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (T.A.H.); (T.A.); (M.S.)
| | - Taher Abu Hejleh
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (T.A.H.); (T.A.); (M.S.)
| | - Maen Abdelrahim
- Section of GI Oncology, Houston Methodist Neal Cancer Center, Houston, TX 77030, USA;
| | - Ali Shamseddine
- Division of Hematology and Oncology, Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon; (A.S.); (L.C.)
| | - Laudy Chehade
- Division of Hematology and Oncology, Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon; (A.S.); (L.C.)
| | - Tala Alawabdeh
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (T.A.H.); (T.A.); (M.S.)
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan;
| | - Mohammad Sammour
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (T.A.H.); (T.A.); (M.S.)
| | - Rim Turfa
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan; (T.A.H.); (T.A.); (M.S.)
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15
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Shi Z, Zhu S, Jin Y, Qi L, Zhou M, Zhou Z, Zhang J, Liu B, Shen J. Lymphocyte-to-C Reactive Protein Ratio is an Independent Predictor of Survival Benefits for Hepatocellular Carcinoma Patients Receiving Radiotherapy. J Hepatocell Carcinoma 2024; 11:305-316. [PMID: 38348098 PMCID: PMC10860807 DOI: 10.2147/jhc.s452424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) has emerged as an alternative approach for patients with hepatocellular carcinoma (HCC), and we aim to find potential prognostic biomarkers for HCC patients who received SBRT. Methods In this study, we retrospectively analyzed HCC patients who underwent SBRT in our institution from January 2018 to December 2022. The inflammatory parameters, along with baseline patients' characteristics were collected to elucidate the potential relationship with survival benefits and liver toxicities. Results Overall, 35 patients were enrolled in our study. For the efficacy population (25 patients who underwent SBRT for primary liver lesions), the objective response rate (ORR) and disease control rate (DCR) were 60% and 100%, respectively. The median progression-free survival (PFS) was 9.9 months [95% confidence interval (CI) 5.6-14.1 months], and the median overall survival (OS) was 18.5 months (95% CI 14.2-22.8 months). We further confirmed that higher baseline lymphocyte-C-reactive protein ratio (LCR) (≥2361.11) was positively related to both longer PFS (12.0 vs 4.3 months, P = 0.002) and OS (21.9 vs 11.4 months, P = 0.022). Moreover, patients with diabetes and higher alpha-fetoprotein (AFP) (≥400 ng/mL) were also found to be associated with worse OS. The most common hepatotoxicity was elevated gamma-glutamyl transferase (GGT) (84.0%). Conclusion In conclusion, for patients with inoperable HCC, SBRT resulted in satisfactory local control, survival benefits, and acceptable liver toxicity. Pre-radiotherapy LCR might be an independent and readily available predictor for survival, which facilitates us to find the most appropriate treatment options.
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Affiliation(s)
- Zhan Shi
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Sihui Zhu
- The Comprehensive Cancer Centre of Nanjing International Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Yuncheng Jin
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Liang Qi
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Mingzhen Zhou
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Ziyan Zhou
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Juan Zhang
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Baorui Liu
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
| | - Jie Shen
- Department of Oncology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu Province, 210008, People’s Republic of China
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16
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Bidarmaghz B, Idrees M, Lee YY, Hodgkinson P. Large hepatocellular carcinoma treated with sequential SBRT and immunotherapy with anti-VEGF (Vascular Endothelial Growth Factor) therapy. BMJ Case Rep 2023; 16:e256931. [PMID: 38061854 PMCID: PMC10711845 DOI: 10.1136/bcr-2023-256931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
Managing large solitary hepatocellular carcinoma (HCC) remains challenging as guidelines recommend a palliative approach given the general poor prognosis without accounting for variations in the underlying tumour biology. Surgical resection provides significantly better survival than other modalities for HCC, but only a small proportion of patients with large tumours qualify for surgical resection. Recently, with technological advances in radiation therapy, stereotactic body radiation therapy (SBRT) has emerged as an alternative treatment option for HCC . In this paper, we present a patient who was diagnosed with a 13 cm HCC with vascular invasion. SBRT was delivered as a locoregional therapy followed by immunotherapy with the outcome of complete pathological response observed on right hemi-hepatectomy.
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Affiliation(s)
- Bardia Bidarmaghz
- Transplant, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Marwan Idrees
- Transplant, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Yoo Young Lee
- Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Peter Hodgkinson
- Transplant, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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17
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Dadrass F, Acree P, Kim E. Chemoembolization Plus Ablation: Current Status. Semin Intervent Radiol 2023; 40:505-510. [PMID: 38274219 PMCID: PMC10807969 DOI: 10.1055/s-0043-1777715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. The treatment landscape for HCC has evolved significantly over the past decade, with several modalities available to treat various stages of disease. The Barcelona Clinic Liver Cancer (BCLC) system provides a foundation for treatment guidance. However, given the complex nature of HCC, a more nuanced approach is often required, especially for lesions sized between 3 and 5 cm. This review aims to analyze the available treatments for early-stage HCC lesions between 3 and 5 cm, with a focus on the therapeutic potential and efficacy of transarterial chemoembolization (TACE)-ablation. Additional therapies including TACE, ablation, transarterial radioembolization, and surgical resection are also reviewed and compared with TACE-ablation. TACE-ablation is a viable therapeutic option for early-stage HCC lesions between 3 and 5 cm. Surgical resection remains the gold standard. Although recent studies suggest radiation segmentectomy may be a curative approach for this patient population, further studies are needed to compare the relative efficacies between TACE-ablation and radiation segmentectomy.
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Affiliation(s)
- Farnaz Dadrass
- Department of Diagnostic, Molecular and Interventional Radiology, Mount Sinai Hospital, New York, New York
| | - Pascal Acree
- Department of Radiology and Imaging, Medical College of Georgia School of Medicine, Medical College of Georgia at Augusta University, Athens, Georgia
| | - Edward Kim
- Department of Diagnostic, Molecular and Interventional Radiology, Mount Sinai Hospital, New York, New York
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18
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Taouli B, Ba-Ssalamah A, Chapiro J, Chhatwal J, Fowler K, Kang TW, Knobloch G, Koh DM, Kudo M, Lee JM, Murakami T, Pinato DJ, Ringe KI, Song B, Tabrizian P, Wang J, Yoon JH, Zeng M, Zhou J, Vilgrain V. Consensus report from the 10th global forum for liver magnetic resonance imaging: multidisciplinary team discussion. Eur Radiol 2023; 33:9167-9181. [PMID: 37439935 PMCID: PMC10667403 DOI: 10.1007/s00330-023-09919-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 07/14/2023]
Abstract
The 10th Global Forum for Liver Magnetic Resonance Imaging was held in October 2021. The themes of the presentations and discussions at this Forum are described in detail in the review by Taouli et al (2023). The focus of this second manuscript developed from the Forum is on multidisciplinary tumor board perspectives in hepatocellular carcinoma (HCC) management: how to approach early-, mid-, and late-stage management from the perspectives of a liver surgeon, an interventional radiologist, and an oncologist. The manuscript also includes a panel discussion by multidisciplinary experts on three selected cases that explore challenging aspects of HCC management. CLINICAL RELEVANCE STATEMENT: This review highlights the importance of a multidisciplinary team approach in liver cancer patients and includes the perspectives of a liver surgeon, an interventional radiologist, and an oncologist, including illustrative case studies. KEY POINTS: • A liver surgeon, interventional radiologist, and oncologist presented their perspectives on the treatment of early-, mid-, and late-stage HCC. • Different perspectives on HCC management between specialties emphasize the importance of multidisciplinary tumor boards. • A multidisciplinary faculty discussed challenging aspects of HCC management, as highlighted by three case studies.
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Affiliation(s)
- Bachir Taouli
- Department of Diagnostic, Molecular, and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jagpreet Chhatwal
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathryn Fowler
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gesine Knobloch
- Global Medical and Clinical Affairs and Digital Development, Radiology, Bayer Pharmaceuticals, Berlin, Germany
| | - Dow-Mu Koh
- Department of Diagnostic Radiology, Royal Marsden Hospital, Sutton, UK
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Parissa Tabrizian
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jin Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou; Liver Disease Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jian Zhou
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Valérie Vilgrain
- Université Paris Cité and Department of Radiology, Assistance-Publique Hôpitaux de Paris, APHP Nord, Hôpital Beaujon, Clichy, France
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19
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Chen CL, Dungca LBP, Yong CC, Chen ICY, Cheng YF, Cheng JY, Chen YY. Proton beam therapy for downstaging hepatocellular carcinoma with lobar portal vein tumor thrombosis to living donor liver transplantation. Hepatobiliary Surg Nutr 2023; 12:966-974. [PMID: 38115927 PMCID: PMC10727813 DOI: 10.21037/hbsn-23-410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Chao-Long Chen
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Leona Bettina P. Dungca
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chee-Chien Yong
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Itsuko Chih-Yi Chen
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Yu-Fan Cheng
- Liver Transplantation Center, Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Jen-Yu Cheng
- Liver Transplantation Center, Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Yen-Yang Chen
- Liver Transplantation Center, Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
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20
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Podesta C, Kayani M, Goody R, Samson A. Combination treatment of HCC with SBRT and immune checkpoint inhibition. Crit Rev Oncol Hematol 2023; 192:104191. [PMID: 37865277 DOI: 10.1016/j.critrevonc.2023.104191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/10/2023] [Accepted: 10/17/2023] [Indexed: 10/23/2023] Open
Abstract
The treatment of unresectable or metastatic HCC has been significantly advanced in recent years by developments in both radiotherapy and systemic cancer therapies. Independently, both Stereotactic Ablative Body Radiotherapy (SBRT) and Immune Checkpoint Inhibitors (ICIs) are licensed for the treatment of these tumours. Building on the successes seen in other solid tumours, there is significant interest in exploring combination treatments. In this review article we briefly present the evidence base for the use of these treatments in patients with HCC. With reference to our current understanding of the immuno-oncology and radiobiology of HCCs, we demonstrate why combining these two modalities is of interest. Finally, we discuss the clinical trials that are currently underway or planned and the direction that future research may take.
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Affiliation(s)
- Christine Podesta
- Leeds Cancer Centre, St James University Hospital, Beckett Street, Leeds, UK
| | - Mahaz Kayani
- Leeds Cancer Centre, St James University Hospital, Beckett Street, Leeds, UK.
| | - Rebecca Goody
- Leeds Cancer Centre, St James University Hospital, Beckett Street, Leeds, UK
| | - Adel Samson
- Leeds Cancer Centre, St James University Hospital, Beckett Street, Leeds, UK
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21
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Lan Y, Pi W, Zhou Z, Meng Y, DanMei, Xu Y, Xia X, WeiWang, Yang H, Spring Kong FM. Effect of radiation fractionation on IDO1 via the NF-κB/COX2 axis in non-small cell lung cancer. Int Immunopharmacol 2023; 124:110956. [PMID: 37751656 DOI: 10.1016/j.intimp.2023.110956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
Radiotherapy (RT) is the mainstay treatment modality for lung cancer. We recently reported that conventionally fractionated radiotherapy (CRT) with daily fractionation of 2Gy significantly increased the activity of indoleamine 2,3-dioxygenase (IDO1), a known immune checkpoint, which predicted poorer long-term survival in patients with non-small cell lung cancer (NSCLC), while stereotactic body radiotherapy (SBRT) using fractionation size of 10Gy did not increase IDO1 activity and had better survival. Here we hypothesized that the hypofractionated SBRT kind of dose fraction stimulates host antitumor immunity via downregulating IDO1 in which CRT could not. We tested this hypothesis in vitro and in vivo using 10Gyx1 and 2Gyx8 fractionations in the laboratory. The results demonstrated that, although there was an initial downregulation after RT, the expression of IDO1 was ultimately upregulated by both fractionation regimens. The 10Gyx1 regimen had minimum upregulation, while the 2Gyx8 regimen significantly increased in IDO1 expression which was positively correlated with the elevated expressions of p-NF-κB and COX2. Pharmacological inhibition of COX2 abolished RT-induced IDO1 expression. Furthermore, the IDO1 inhibitor, D-1-methyl-tryptophan (D-1MT), exerted RT-related tumor-killing effects in the NSCLC cell lines and mouse models. These findings suggest that, in addition to being an immune suppressor, IDO1 may serve as an adaptive resistance factor in RT. Furthermore, an unappreciated mechanism may exist, where a larger fraction size might be superior to conventional sizes in cancer treatment. This study may provide a rationale for future research in using IDO1 as a biomarker to personalize RT dose fractionation and COX2 inhibitor to decrease radiation immune suppression from CRT.
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Affiliation(s)
- Yanli Lan
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui City People's Hospital, Department of Oncology, Lishui 323000, Zhejiang Province, China
| | - Wenhu Pi
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - Zhangjie Zhou
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Department of General Medicine, Lishui 323000, Zhejiang Province, China
| | - Yinnan Meng
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Department of Clinical Oncology, Hong Kong University Shenzhen Hospital, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - DanMei
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - Yixiu Xu
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - Xinhang Xia
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - WeiWang
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - HaiHua Yang
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China.
| | - Feng-Ming Spring Kong
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Department of Clinical Oncology, Hong Kong University Shenzhen Hospital, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China.
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22
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Elderkin J, Al Hallak N, Azmi AS, Aoun H, Critchfield J, Tobon M, Beal EW. Hepatocellular Carcinoma: Surveillance, Diagnosis, Evaluation and Management. Cancers (Basel) 2023; 15:5118. [PMID: 37958294 PMCID: PMC10647678 DOI: 10.3390/cancers15215118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC) ranks fourth in cancer-related deaths worldwide. Semiannual surveillance of the disease for patients with cirrhosis or hepatitis B virus allows for early detection with more favorable outcomes. The current underuse of surveillance programs demonstrates the need for intervention at both the patient and provider level. Mail outreach along with navigation provision has proven to increase surveillance follow-up in patients, while provider-targeted electronic medical record reminders and compliance reports have increased provider awareness of HCC surveillance. Imaging is the primary mode of diagnosis in HCC with The Liver Imaging Reporting and Data System (LI-RADS) being a widely accepted comprehensive system that standardizes the reporting and data collection for HCC. The management of HCC is complex and requires multidisciplinary team evaluation of each patient based on their preference, the state of the disease, and the available medical and surgical interventions. Staging systems are useful in determining the appropriate intervention for HCC. Early-stage HCC is best managed by curative treatment modalities, such as liver resection, transplant, or ablation. For intermediate stages of the disease, transarterial local regional therapies can be applied. Advanced stages of the disease are treated with systemic therapies, for which there have been recent advances with new drug combinations. Previously sorafenib was the mainstay systemic treatment, but the recent introduction of atezolizumab plus bevacizumab proves to have a greater impact on overall survival. Although there is a current lack of improved outcomes in Phase III trials, neoadjuvant therapies are a potential avenue for HCC management in the future.
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Affiliation(s)
- Jessica Elderkin
- Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Najeeb Al Hallak
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; (N.A.H.); (A.S.A.)
| | - Asfar S. Azmi
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; (N.A.H.); (A.S.A.)
| | - Hussein Aoun
- Department of Radiology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; (H.A.); (J.C.)
| | - Jeffrey Critchfield
- Department of Radiology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; (H.A.); (J.C.)
| | - Miguel Tobon
- Department of Surgery, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - Eliza W. Beal
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA; (N.A.H.); (A.S.A.)
- Department of Surgery, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA;
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23
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Yoon SM. Novel paradigm in the treatment of hepatocellular carcinoma: Anticipating breakthroughs with particle therapy. Clin Mol Hepatol 2023; 29:977-979. [PMID: 37652077 PMCID: PMC10577346 DOI: 10.3350/cmh.2023.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Sang Min Yoon
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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24
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Xie J, Jia L, Xie P, Yin X, Zhu W, Zhao H, Wang X, Meng X, Xing L, Zhao H, Li X. Efficacy and safety of epigallocatechin-3-gallate in treatment acute severe dermatitis in patients with cancer receiving radiotherapy: a phase I clinical trial. Sci Rep 2023; 13:13865. [PMID: 37620508 PMCID: PMC10449912 DOI: 10.1038/s41598-023-40881-4] [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: 05/24/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
To evaluate the safety and effectiveness of epigallocatechin-3-gallate (EGCG) solution treating the acute severe dermatitis in patients receiving radiotherapy. This phase I research enrolled patients with thoracic cancer receiving radiotherapy at Shandong Cancer Hospital and Institute in Shandong, China. EGCG solution was sprayed to the radiation field when grade III radiation-induced dermatitis (RID) first appearance. EGCG concentration escalated from 660 to 2574 μmol/L using modified-Fibonacci dose-escalation. RID and related symptoms were followed up every day. Between March 2021 and November 2021, 19 patients were enrolled in this phase I research. The median dose of grade III RID first observation was 44 Gy (30.6-52 Gy). As the EGCG treatment was performed continuously, all these grade III RID reactions were significantly decreased to grade I or grade II RID at three days after use of EGCG (p < 0.001). Significant relief can be observed in burning sensation (p < 0.001), tractive sensation (p < 0.001), tenderness (p < 0.001), erythema (p < 0.001), itching (p < 0.001) and pain (p < 0.001) after 15 days of EGCG treatment. No radiation therapy delay or interruption for all 19 patients. No adverse events were observed and reported associated with EGCG. The highest dose of this Phase I trial (2574 μmol/L) was recommended for continuous Phase II trial for further evaluation. In this phase I clinical research, use of EGCG solution is safe and can significantly relief grade III RID in patients receiving radiotherapy. Thus, EGCG might be a new choice for acute sever RID.Trial Registration: ClinicalTrials.gov Identifier: NCT02580279 (Full date of first registration: 12/2014).
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Affiliation(s)
- Jingjing Xie
- Department of Radiation Oncology, Shandong First Medical University Affiliated Cancer Hospital (Shandong Academy of Medical Sciences), Jinan, 250117, Shandong, China
| | - Li Jia
- Department of Radiation Oncology, The Fourth People's Hospital of Jinan, Jinan, 250031, Shandong, China
| | - Peng Xie
- Department of Radiation Oncology, Shandong First Medical University Affiliated Cancer Hospital (Shandong Academy of Medical Sciences), Jinan, 250117, Shandong, China.
| | - Xiaoyan Yin
- Department of Radiation Oncology, Shandong First Medical University Affiliated Cancer Hospital (Shandong Academy of Medical Sciences), Jinan, 250117, Shandong, China
| | - Wanqi Zhu
- Department of Radiation Oncology, Shandong First Medical University Affiliated Cancer Hospital (Shandong Academy of Medical Sciences), Jinan, 250117, Shandong, China
| | - Hong Zhao
- Department of Radiation Oncology, Shandong First Medical University Affiliated Cancer Hospital (Shandong Academy of Medical Sciences), Jinan, 250117, Shandong, China
| | - Xin Wang
- Department of Radiation Oncology, Shandong First Medical University Affiliated Cancer Hospital (Shandong Academy of Medical Sciences), Jinan, 250117, Shandong, China
| | - Xiangjiao Meng
- Department of Radiation Oncology, Shandong First Medical University Affiliated Cancer Hospital (Shandong Academy of Medical Sciences), Jinan, 250117, Shandong, China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong First Medical University Affiliated Cancer Hospital (Shandong Academy of Medical Sciences), Jinan, 250117, Shandong, China
| | - Hanxi Zhao
- Department of Radiation Oncology, Shandong First Medical University Affiliated Cancer Hospital (Shandong Academy of Medical Sciences), Jinan, 250117, Shandong, China.
| | - Xiaolin Li
- Department of Radiation Oncology, Shandong First Medical University Affiliated Cancer Hospital (Shandong Academy of Medical Sciences), Jinan, 250117, Shandong, China.
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25
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Zeng H, Su K, Chen X, Li X, Wen L, Song Y, Chen L, Li H, Guo L, Han Y. A propensity score matching study on survival benefits of radiotherapy in patients with inoperable hepatocellular carcinoma. Sci Rep 2023; 13:6879. [PMID: 37106014 PMCID: PMC10140032 DOI: 10.1038/s41598-023-34135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/25/2023] [Indexed: 04/29/2023] Open
Abstract
With the advancements in radiotherapy (RT) in recent years, several studies have shown that RT can significantly prolong the survival of patients with hepatocellular carcinoma (HCC). As a noninvasive treatment option, the application of RT for the treatment of HCC is garnering increasing attention. In this retrospective study, we included data from 13,878 patients with HCC from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019 and 325 patients with HCC treated in three tertiary hospitals in China between 2015 and 2021. Patient data were divided into RT and non-RT groups based on whether the patients underwent RT. Propensity score matching analysis was performed to minimize the deviation between the RT and non-RT groups, and the Kaplan-Meier method, Cox proportional hazard model, and nomogram were used to assess the efficacy of undergoing RT. The median overall survival (mOS) of the RT group was significantly longer compared with that of the non-RT group for the SEER data (16 months versus 9 months, p < 0.01). Similarly, the survival benefit was more significant in the RT group than in the non-RT group at our hospitals (34.1 months versus 15.4 months, p < 0.01). Furthermore, multivariate Cox analysis revealed that factors, including tumor (T) stage, patient age, tumor grade, serum AFP level, and chemotherapy, also affected patient survival. Moreover, these factors were also used to construct a nomogram. Subgroup analysis of these factors showed that RT was effective in prolonging patient survival in different populations. RT significantly improves the survival time of patients with inoperable HCC, thereby providing a basis for selecting HCC patients who can benefit from RT.
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Affiliation(s)
- Hao Zeng
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan Province, China
| | - Ke Su
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan Province, China
| | - Xiaojing Chen
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan Province, China
| | - Xueting Li
- Department of Oncology, 363 Hospital, Chengdu, China
| | - Lianbin Wen
- Department of Geriatric Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Yanqiong Song
- Department of Radiotherapy, School of Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Lan Chen
- Department of Oncology and Hematology, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Han Li
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan Province, China
| | - Lu Guo
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yunwei Han
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan Province, China.
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26
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Matsuo Y. Stereotactic Body Radiotherapy for Hepatocellular Carcinoma: A Brief Overview. Curr Oncol 2023; 30:2493-2500. [PMID: 36826151 PMCID: PMC9956001 DOI: 10.3390/curroncol30020190] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT), a type of external beam radiotherapy, yields local control of hepatocellular carcinoma (HCC) at rates as high as 90%. SBRT has been recognized as an alternative therapy for patients for whom standard modalities such as surgery (resection or transplantation) or ablation are deemed unsuitable. SBRT has the potential to improve the prognosis of HCC, as it can be used as an adjunct to other treatment modalities. The assessment of post-SBRT images of the treated tumor and surrounding normal liver tissue requires special attention. Future research is warranted to determine how best to use SBRT versus other therapies and how to combine them.
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Affiliation(s)
- Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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27
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Metastasis of Hepatocellular Carcinoma in the Pouch of Douglas Successfully Treated by Radiation Therapy: A Case Report. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010225. [PMID: 36676174 PMCID: PMC9862896 DOI: 10.3390/life13010225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
Metastasis of hepatocellular carcinoma (HCC) in the pouch of Douglas is relatively rare. A 65-year-old man with liver cirrhosis was admitted for detailed examination of a pelvic tumor. He had a previous history of ruptured HCC, and received emergent hemostasis with transcatheter arterial embolization followed by curative ablation. His blood tests showed an increase in des-gamma-carboxy prothrombin (DCP). Contrast-enhanced computed tomography (CE-CT) revealed a heterogeneously enhanced large pelvic tumor, but no additional tumorous lesions were detected in other organs, including the lungs, liver and abdominal lymph nodes. The colonoscopy showed compression by an extra-luminal/submucosal tumor, and computed tomography-guided percutaneous needle biopsy revealed that the pelvic tumor was metastasis of HCC. Because of the poor liver function, the solitary pelvic tumor was treated with three-dimensional conformal radiation therapy (3D-CRT). The tumor size and the DCP value were markedly decreased after radiation therapy. Nine months later, occasional mild bloody stool due to radiation proctitis was observed; however, no serious side effects occurred. Our case suggests that radiation therapy may be a therapeutic option for a solitary metastatic lesion of HCC in the pouch of Douglas.
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28
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Zhou J, Kang M, Wang Y, Higgins KA, Simone CB, Patel P, McDonald MW, Lin L, Bohannon D. Proton liver stereotactic body radiation therapy: Treatment techniques and dosimetry feasibility from a single institution. JOURNAL OF RADIOSURGERY AND SBRT 2023; 9:33-42. [PMID: 38029011 PMCID: PMC10681147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023]
Abstract
Purpose To assess the resulting dosimetry characteristics of simulation and planning techniques for proton stereotactic body radiation therapy (SBRT) of primary and secondary liver tumors. Methods Consecutive patients treated under volumetric daily image guidance with liver proton SBRT between September 2019 and March 2022 at Emory Proton Therapy Center were included in this study. Prescriptions ranged from 40 Gy to 60 Gy in 3- or 5-fraction regimens, and motion management techniques were used when target motion exceeded 5 mm. 4D robust optimization was used when necessary. Dosimetry evaluation was conducted for ITV V100, D99, Dmax, and liver-ITV mean dose and D700cc. Statistical analysis was performed using independent-samples Mann-Whitney U tests. Results Thirty-six tumors from 29 patients were treated. Proton therapy for primary and secondary liver tumors using motion management techniques and robust optimization resulted in high target coverage and low doses to critical organs. The median ITV V100% was 100.0%, and the median ITV D99% was 111.3%. The median liver-ITV mean dose and D700cc were 499 cGy and 5.7 cGy, respectively. The median conformity index (CI) was 1.03, and the median R50 was 2.56. Except for ITV D99% (primary 118.1% vs. secondary 107.2%, p = 0.005), there were no significant differences in age, ITV volume, ITV V100%, ITV maximum dose, liver-ITV mean dose, or D700cc between primary and secondary tumor groups. Conclusion The study demonstrated that proton therapy with motion management techniques and robust optimization achieves excellent target coverage with low normal liver doses for primary and secondary liver tumors. The results showed high target coverage, high conformality, and low doses to the liver.
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Affiliation(s)
- Jun Zhou
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | - Yinan Wang
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | | | - Pretesh Patel
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Mark W. McDonald
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Liyong Lin
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Duncan Bohannon
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
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29
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Selecting the Best Approach for the Treatment of Multiple Non-Metastatic Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14235997. [PMID: 36497478 PMCID: PMC9737585 DOI: 10.3390/cancers14235997] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
According to the Barcelona Clinic Liver Cancer (BCLC) staging system, the optimal strategy for patients with multiple HCC within the Milan Criteria is liver transplantation (LT). However, LT cannot be offered to all the patients due to organ shortages and long waiting lists, as well as because of the advanced disease carrying a high risk of poor outcomes. For early stages, liver resection (LR) or thermal ablation (TA) can be proposed, while trans-arterial chemoembolization (TACE) still remains the treatment of choice for intermediate stages (BCLC-B). Asian guidelines and the National Comprehensive Cancer Network suggest LR for resectable multinodular HCCs, even beyond Milan criteria. In this scenario, a growing body of evidence shows better outcomes after surgical resection when compared with TACE. Trans-arterial radioembolization (TARE) and stereotaxic body radiation therapy (SBRT) can also play an important role in this setting. Furthermore, the role of minimally invasive liver surgery (MILS) specifically for patients with multiple HCC is still not clear. This review aims to summarize current knowledge about the best therapeutical strategy for multiple HCC while focusing on the role of minimally invasive surgery and on the most attractive future perspectives.
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30
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Tadimalla S, Wang W, Haworth A. Role of Functional MRI in Liver SBRT: Current Use and Future Directions. Cancers (Basel) 2022; 14:cancers14235860. [PMID: 36497342 PMCID: PMC9739660 DOI: 10.3390/cancers14235860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) is an emerging treatment for liver cancers whereby large doses of radiation can be delivered precisely to target lesions in 3-5 fractions. The target dose is limited by the dose that can be safely delivered to the non-tumour liver, which depends on the baseline liver functional reserve. Current liver SBRT guidelines assume uniform liver function in the non-tumour liver. However, the assumption of uniform liver function is false in liver disease due to the presence of cirrhosis, damage due to previous chemo- or ablative therapies or irradiation, and fatty liver disease. Anatomical information from magnetic resonance imaging (MRI) is increasingly being used for SBRT planning. While its current use is limited to the identification of target location and size, functional MRI techniques also offer the ability to quantify and spatially map liver tissue microstructure and function. This review summarises and discusses the advantages offered by functional MRI methods for SBRT treatment planning and the potential for adaptive SBRT workflows.
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Affiliation(s)
- Sirisha Tadimalla
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia
- Correspondence:
| | - Wei Wang
- Crown Princess Mary Cancer Centre, Sydney West Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW 2145, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia
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