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Tsai YL, Yu PC, Nien HH, Lu TP. Time variation of high-risk groups for liver function deteriorations within fluctuating long-term liver function after hepatic radiotherapy in patients with hepatocellular carcinoma. Eur J Med Res 2024; 29:104. [PMID: 38326881 PMCID: PMC10848403 DOI: 10.1186/s40001-024-01692-z] [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: 05/02/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024] Open
Abstract
PURPOSE The purpose of this study is to find essential risk factors associated with liver function (LF) deteriorations within fluctuating long-term LF and their time-varying effects in patients with hepatocellular carcinoma (HCC) receiving hepatic radiotherapy and to identify high-risk groups for adverse LF deteriorations and their changes over time in facilitating the prevention of hepatic decompensation and the improvement of survival. MATERIALS AND METHODS A total of 133 HCC patients treated by hepatic radiotherapy were enrolled. A study design was conducted to convert posttreatment long-term LF with fluctuating levels over time to recurrent LF events using defined upgrades in a grading scale. The hazard ratios (HR) of pretreatment biochemical, demographic, clinical, and dosimetric factors in developing posttreatment LF events were estimated using the Cox model. Methodologies of the counting process approach, robust variance estimation, goodness-of-fit testing based on the Schoenfeld residuals, and time-dependent covariates in survival analysis were employed to handle the correlation within subjects and evaluate the time-varying effects during long-term follow-up. RESULTS Baseline LF score before radiotherapy and gender were significant factors. Initial HR in developing LF events was 1.17 (95% CI 1.11-1.23; P < 0.001) for each increase of baseline LF score and kept almost constant over time (HR, 1.00; 95% CI 1.00-1.01; P = 0.065). However, no difference was observed regarding initial hazards for gender (HR, 1.00; 95% CI 0.64-1.56; P = 0.994), but the hazard for women got higher monthly over time compared with men (HR, 1.04; 95% CI 1.01-1.07; P = 0.006). CONCLUSIONS High-risk groups for adverse LF deteriorations after hepatic radiotherapy may change over time. Patients with poor baseline LF are vulnerable from the beginning. Women require prevention strategies and careful monitoring for deteriorations at a later stage.
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Affiliation(s)
- Yu-Lun Tsai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Pei-Chieh Yu
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsin-Hua Nien
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Bioinformatics and Biostatistics Core, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan.
- Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Jang WI, Jo S, Moon JE, Bae SH, Park HC. The Current Evidence of Intensity-Modulated Radiotherapy for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:4914. [PMID: 37894281 PMCID: PMC10605127 DOI: 10.3390/cancers15204914] [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: 08/22/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Intensity-modulated radiotherapy (IMRT), an advanced RT technique, is a considerable treatment option for hepatocellular carcinoma (HCC). However, the distinguishing features of IMRT for HCC have not yet been clearly defined. A systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The PubMed/MedLine, Embase, Cochrane Library, Web of Science, and KoreaMed were used to screen eligible studies focusing on treatment outcomes after IMRT for HCC until 18 April 2023. A total of 1755 HCC patients receiving IMRT among 29 studies from 2009 to 2023 were selected for the meta-analysis. The median proportion of Barcelona Clinic Liver Cancer stage C was 100% (range: 38-100%). Nineteen studies used combined treatment. Pooled rates of response and 1-year local control were 58% (95% confidence interval [CI], 50-65%) and 84% (95% CI, 70-94%), respectively. The median overall survival (OS) was 13 months (range: 5-45 months), and pooled 1- and 3-year OS rates were 59% (95% CI, 52-66%), and 23% (95% CI, 14-33%), respectively. Pooled rates of classic radiation-induced liver disease (RILD), nonclassic RILD, and hepatic toxicity ≥ grade 3 were 2%, 4%, and 4%, respectively. Although most patients had advanced-stage HCC and combined treatment was commonly used, IMRT for HCC showed similar survival to existing RT modalities and relatively low severe toxicity.
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Affiliation(s)
- Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea;
| | - Sunmi Jo
- Department of Radiation Oncology, Haeundae Paik Hospital, Inje University School of Medicine, 875, Haeun-daero, Haeundae-gu, Busan 48108, Republic of Korea;
| | - Ji Eun Moon
- Department of Biostatistics, Soonchunhyang University College of Medicine, Bucheon, 170 Jomaru-ro, Wongmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea;
| | - Sun Hyun Bae
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, 170 Jomaru-ro, Wongmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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Roberts HJ, Hong TS. Proton versus photon radiotherapy for hepatocellular carcinoma: Current data and technical considerations. JOURNAL OF RADIOSURGERY AND SBRT 2023; 9:9-16. [PMID: 38029005 PMCID: PMC10681146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/15/2023] [Indexed: 12/01/2023]
Abstract
Radiation is an accepted standard of care for unresectable hepatocellular carcinoma (HCC), and while photon radiation is the current standard, the use of proton beam radiotherapy (PBT) is an active area of investigation given its ability to better spare uninvolved liver. Patients with HCC typically have background liver disease and many patients die of their underlying liver function in the absence of tumor progression. Early photon-based series showed promising rates of local control however the risk of non-classic radiation induced liver disease (RILD) remains relatively high and may be associated with poorer outcomes. There is a theoretical advantage to PBT in its ability to spare uninvolved liver parenchyma and potentially allow for further dose escalation. There are technical considerations for image guidance, respiratory motion management, and conformality to both PBT and photon radiotherapy that are critical to optimizing each modality. Whether the use of PBT affects clinical outcomes is the subject of the ongoing NRG Oncology GI003 trial, that randomizes patients with HCC to protons or photons. This article reviews the technical differences and literature on individual outcomes for PBT and photon radiation as well as the available comparative data.
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Affiliation(s)
- Hannah J Roberts
- Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
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Vardar BU, Meram E, Karaoglu K, Liang M, Yu M, Laeseke P, Ozkan OS. Radioembolization Followed by Transarterial Chemoembolization in Hepatocellular Carcinoma. Cureus 2022; 14:e23783. [PMID: 35518553 PMCID: PMC9063732 DOI: 10.7759/cureus.23783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/05/2022] Open
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Jia J, Sun J, Duan X, Li W. Clinical Values and Markers of Radiation-Induced Liver Disease for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus Treated With Stereotactic Body Radiotherapy. Front Oncol 2022; 11:760090. [PMID: 34970485 PMCID: PMC8712705 DOI: 10.3389/fonc.2021.760090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Information about radiation-induced liver disease (RILD) in hepatocellular carcinoma (HCC) patients preexisting hepatitis B cirrhosis with portal vein tumor thrombus (PVTT) extended to the main portal vein treated with stereotactic body radiotherapy (SBRT) is still inadequate and the predictive markers for RILD have not been cleared in these patients. The aim of the study is to identify factors that can be used to predict RILD and to evaluate the influence of RILD in these patients. Methods In our study, 59 patients were analyzed and evaluated from December 2015 to June 2019, according to the entry criteria. After treatment, 59 patients were followed up within the first month and then every 3 months. Hematology test, tumor markers, three-phasic CT scan of the lungs, and CT or MRI scan of the liver were performed at each follow up. Results Median overall survival time was 10.7 months (range, 5.8 to 14.9). RILD appeared in 17 of the 59 patients (28.8%) at the 3rd month after SBRT. In the univariate analysis, not only the CP score class (A or B) but also each different pretreatment CP score (p < 0.05) was a significant predictive factor of RILD. More RILD cases were detected with the increase of CP score. The recovery rate decreased as the baseline CP score increased (p < 0.05). It was found that the overall survival time was affected by only baseline CP score and RILD (p < 0.05). Conclusions The development of RILD has a dependency on the CP score in these patients. CP scores before treatment and RILD are significantly associated with overall survival. SBRT is an effective and safe method for patients with CP ≤ B7. For patients with CP-B8, liver function should be monitored more frequently. It is not safe enough for the SBRT treatment in CP-B9 patients.
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Affiliation(s)
- Jun Jia
- Radiation Oncology Department, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jing Sun
- Radiation Oncology Department, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xuezhang Duan
- Radiation Oncology Department, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Wengang Li
- Radiation Oncology Department, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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Bhangoo RS, Mullikin TC, Ashman JB, Cheng TW, Golafshar MA, DeWees TA, Johnson JE, Shiraishi S, Liu W, Hu Y, Merrell KW, Haddock MG, Krishnan S, Rule WG, Sio TT, Hallemeier CL. Intensity Modulated Proton Therapy for Hepatocellular Carcinoma: Initial Clinical Experience. Adv Radiat Oncol 2021; 6:100675. [PMID: 34409199 PMCID: PMC8361033 DOI: 10.1016/j.adro.2021.100675] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/14/2021] [Accepted: 02/10/2021] [Indexed: 02/08/2023] Open
Abstract
Purpose Our purpose was to assess the safety and efficacy of intensity modulated proton therapy (IMPT) for the treatment of hepatocellular carcinoma (HCC). Methods and Materials A retrospective review was conducted on all patients who were treated with IMPT for HCC with curative intent from June 2015 to December 2018. All patients had fiducials placed before treatment. Inverse treatment planning used robust optimization with 2 to 3 beams. The majority of patients were treated in 15 fractions (n = 30, 81%, 52.5-67.5 Gy, relative biological effectiveness), whereas the remainder were treated in 5 fractions (n = 7, 19%, 37.5-50 Gy, relative biological effectiveness). Daily image guidance consisted of orthogonal kilovoltage x-rays and use of a 6° of freedom robotic couch. Outcomes (local control, progression free survival, and overall survival) were determined using Kaplan-Meier methods. Results Thirty-seven patients were included. The median follow-up for living patients was 21 months (Q1-Q3, 17-30 months). Pretreatment Child-Pugh score was A5-6 in 70% of patients and B7-9 in 30% of patients. Nineteen patients had prior liver directed therapy for HCC before IMPT. Eight patients (22%) required a replan during treatment, most commonly due to inadequate clinical target volume coverage. One patient (3%) experienced a grade 3 acute toxicity (pain) with no recorded grade 4 or 5 toxicities. An increase in Child-Pugh score by ≥ 2 within 3 months of treatment was observed in 6 patients (16%). At 1 year, local control was 94%, intrahepatic control was 54%, progression free survival was 35%, and overall survival was 78%. Conclusions IMPT is safe and feasible for treatment of HCC.
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Affiliation(s)
- Ronik S Bhangoo
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Trey C Mullikin
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Tiffany W Cheng
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Todd A DeWees
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.,Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
| | | | - Satomi Shiraishi
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Yanle Hu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | | | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
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Parzen JS, Hartsell W, Chang J, Apisarnthanarax S, Molitoris J, Durci M, Tsai H, Urbanic J, Ashman J, Vargas C, Stevens C, Kabolizadeh P. Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group. Radiat Oncol 2020; 15:255. [PMID: 33148296 PMCID: PMC7643436 DOI: 10.1186/s13014-020-01703-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/29/2020] [Indexed: 01/07/2023] Open
Abstract
Background Recent advances in radiotherapy techniques have allowed ablative doses to be safely delivered to inoperable liver tumors. In this setting, proton beam radiotherapy (PBT) provides the means to escalate radiation dose to the target volume while sparing the uninvolved liver. This study evaluated the safety and efficacy of hypofractionated PBT for liver tumors, predominantly hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). Methods We evaluated the prospective registry of the Proton Collaborative Group for patients undergoing definitive PBT for liver tumors. Demographic, clinicopathologic, toxicity, and dosimetry information were compiled. Results To date, 63 patients have been treated at 9 institutions between 2013 and 2019. Thirty (48%) had HCC and 25 (40%) had ICC. The median dose and biological equivalent dose (BED) delivered was 58.05 GyE (range 32.5–75) and 80.5 GyE (range 53.6–100), respectively. The median mean liver BED was 13.9 GyE. Three (4.8%) patients experienced at least one grade ≥ 3 toxicity. With median follow-up of 5.1 months (range 0.1–40.8), the local control (LC) rate at 1 year was 91.2% for HCC and 90.9% for ICC. The 1-year LC was significantly higher (95.7%) for patients receiving BED greater than 75.2 GyE than for patients receiving BED of 75.2 GyE or lower (84.6%, p = 0.029). The overall survival rate at 1 year was 65.6% for HCC and 81.8% for ICC. Conclusions Hypofractionated PBT results in excellent LC, sparing of the uninvolved liver, and low toxicity, even in the setting of dose-escalation. Higher dose correlates with improved LC, highlighting the importance of PBT especially in patients with recurrent or bulky disease.
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Affiliation(s)
| | - William Hartsell
- Northwestern Medicine Chicago Proton Center, Warrenville, IL, USA
| | - John Chang
- Oklahoma Proton Center, Oklahoma City, OK, USA
| | | | | | | | - Henry Tsai
- Princeton ProCure Proton Therapy Center, Kendall Park, NJ, USA
| | - James Urbanic
- California Protons Therapy Center, San Diego, CA, USA
| | | | | | | | - Peyman Kabolizadeh
- Beaumont Proton Therapy Center, Royal Oak, MI, USA. .,Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, 3601 W Thirteen Mile Rd, Royal Oak, MI, 48073, USA.
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Thermal Ablation Versus Stereotactic Body Radiotherapy After Transarterial Chemoembolization for Inoperable Hepatocellular Carcinoma: A Propensity Score-Weighted Analysis. AJR Am J Roentgenol 2020; 217:691-698. [PMID: 32997517 DOI: 10.2214/ajr.20.24117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Transarterial chemoembolization (TACE) has synergistic properties when combined with ablative therapies for hepatocellular carcinoma (HCC). OBJECTIVE. The purpose of our study was to compare outcomes for inoperable HCC between TACE with percutaneous thermal ablation (TACE-TA) and TACE with stereotactic body radiotherapy (TACE-SBRT) using propensity score-weighted cohorts. METHODS. This retrospective study included 190 patients with a single inoperable HCC treated from 2007 to 2018 by either TACE-SBRT (n = 90) or TACE-TA (n = 100). The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS) and hepatotoxicity (defined as Child-Pugh score elevation of ≥ 2 within 2-6 months after treatment). Fine-Gray competing risk models with propensity score weighting and transplant as the competing risk factor were used to model OS and PFS. RESULTS. The median follow-up time was 48.2 months. Both OS and PFS were significantly higher for TACE-TA (77% and 76%, respectively, at 2 years) than TACE-SBRT (49% and 50%, respectively, at 2 years) in the propensity score-weighted multivariate model (OS: subdistribution hazard ratio [sHR] = 2.70, p < .001; PFS: sHR = 1.71, p = .02). Treatment-related hepatotoxicity occurred in 9% of patients who underwent TACE-TA versus 27% of those who underwent TACE-SBRT (p = .01). For the subset of patients with Barcelona Clinic Liver Cancer A HCC and Child-Pugh A cirrhosis (TACE-SBRT, n = 36 patients; TACE-TA, n = 55 patients), OS (p = .11) and PFS (p = .19) were not significantly different between the two treatment modalities. CONCLUSION. Compared with TACE-SBRT, TACE-TA showed superior OS and PFS, possibly from its lesser hepatotoxicity. The two strategies did not differ in OS and PFS for patients with the earliest-stage HCC and preserved liver function. CLINICAL IMPACT. Across all patients, TACE-TA may be superior to TACE-SBRT for inoperable HCC.
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Liu K, Zhou C, Lv W, Cheng D, Lu D, Zhang Z, Xiao J, Zhang X, Fang W. Factors to transcatheter arterial chemoembolization Liver Cancer stage C. MINIM INVASIV THER 2020; 29:49-55. [PMID: 30849260 DOI: 10.1080/13645706.2019.1575241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: To establish a predictive model to demonstrate that transcatheter arterial chemoembolization (TACE) prolonged survival time in patients with Barcelona Clinic Liver Cancer (BCLC) stage-C HCC.Material and methods: Patients with BCLC stage C HCC treated between January 2009 and April 2016 were included. The training group (n = 336) and control group (n = 141) underwent TACE as a first or supportive treatment. Factors related to survival time were retrospectively analyzed by multivariate logistic regression to establish a predictive model. Validation of the model was undertaken prospectively in a validation group (n = 159) that underwent TACE as first treatment between May 2016 and December 2017.Results: Classification of portal vein tumor thrombus, maximum tumor size, Child-Pugh score, and log alphafoetoprotein levels were independent risk factors included in the mathematical model. Receiver operating characteristic curves confirmed the model was helpful in predicting survival time. The area under the curve was 0.714 (95% confidence interval, 0.659-0.769). A cutoff value of 7.1 months had maximum Youden indeces of 0. 458, sensitivity 62.4%, and specificity 83.8%. The validation group supported the model.Conclusions: Portal vein tumor thrombus, maximum tumor size, Child-Pugh score, and log alphafoetoprotein levels helped predict survival time in patients with BCLC stage-C HCC.
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Affiliation(s)
- Kaicai Liu
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chunze Zhou
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Weifu Lv
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Delei Cheng
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Dong Lu
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhengfeng Zhang
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jingkun Xiao
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xingming Zhang
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Weiwei Fang
- Department of Interventional Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
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Dose escalation by intensity modulated radiotherapy in liver-directed concurrent chemoradiotherapy for locally advanced BCLC stage C hepatocellular carcinoma. Radiother Oncol 2019; 133:1-8. [DOI: 10.1016/j.radonc.2018.12.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/22/2022]
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Abstract
Dosimetry for yttrium-90 radioembolization continues to generate interest and controversy, as multiple approaches have been used effectively. Traditionally, simple formulas primarily based on patients' body weight or perfused liver volume were used. Over the past several years, dosimetry refinements have led to marked improvements in this therapy from both a safety and efficacy standpoint. Technetium-99m macroaggregated albumin single photon emission computed tomography (SPECT) optimizes pretreatment dosimetry to ensure delivery of a therapeutic radiation dose to the tumor while minimizing nontarget radiation to healthy hepatic tissue. Post-treatment yttrium-90 PET utilizing the inherent internal pair production of yttrium-90 accurately calculates the absorbed dose to tumors and to the normal hepatic parenchyma, which correlates with patient outcomes. As dosimetric calculations become more complex, quantitative imaging with Tc-99m SPECT and Y-90 PET may set the new standard for radioembolization dosimetry.
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Affiliation(s)
- Bashir A Tafti
- Section of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Siddharth A Padia
- Section of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
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12
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Sanford NN, Pursley J, Noe B, Yeap BY, Goyal L, Clark JW, Allen JN, Blaszkowsky LS, Ryan DP, Ferrone CR, Tanabe KK, Qadan M, Crane CH, Koay EJ, Eyler C, DeLaney TF, Zhu AX, Wo JY, Grassberger C, Hong TS. Protons versus Photons for Unresectable Hepatocellular Carcinoma: Liver Decompensation and Overall Survival. Int J Radiat Oncol Biol Phys 2019; 105:64-72. [PMID: 30684667 DOI: 10.1016/j.ijrobp.2019.01.076] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/29/2018] [Accepted: 01/13/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Ablative radiation therapy is increasingly being used for hepatocellular carcinoma (HCC) resulting in excellent local control rates; however, patients without evidence of disease progression often die from liver failure. The clinical benefit of proton- over photon-based radiation therapy is unclear. We therefore sought to compare clinical outcomes of proton versus photon ablative radiation therapy in patients with unresectable HCC. METHODS AND MATERIALS This is a single-institution retrospective study of patients treated during 2008 to 2017 with nonmetastatic, unresectable HCC not previously treated with liver-directed radiation therapy and who did not receive further liver-directed radiation therapy within 12 months after completion of index treatment. The primary outcome, overall survival (OS), was assessed using Cox regression. Secondary endpoints included incidence of non-classic radiation-induced liver disease (defined as increase in baseline Child-Pugh score by ≥2 points at 3 months posttreatment), assessed using logistic regression, and locoregional recurrence, assessed using Fine-Gray regression for competing risks. All outcomes were measured from radiation start date. RESULTS The median follow-up was 14 months. Of 133 patients with median age 68 years and 75% male, 49 (37%) were treated with proton radiation therapy. Proton radiation therapy was associated with improved OS (adjusted hazard ratio, 0.47; P = .008; 95% confidence interval [CI], 0.27-0.82). The median OS for proton and photon patients was 31 and 14 months, respectively, and the 24-month OS for proton and photon patients was 59.1% and 28.6%, respectively. Proton radiation therapy was also associated with a decreased risk of non-classic radiation-induced liver disease (odds ratio, 0.26; P = .03; 95% CI, 0.08-0.86). Development of nonclassic RILD at 3 months was associated with worse OS (adjusted hazard ratio, 3.83; P < .001; 95% CI, 2.12-6.92). There was no difference in locoregional recurrence, including local failure, between protons and photons. CONCLUSIONS Proton radiation therapy was associated with improved survival, which may be driven by decreased incidence of posttreatment liver decompensation. Our findings support prospective investigations comparing proton versus photon ablative radiation therapy for HCC.
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Affiliation(s)
- Nina N Sanford
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Bridget Noe
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Beow Y Yeap
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lipika Goyal
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey W Clark
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jill N Allen
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - David P Ryan
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Kenneth K Tanabe
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Christopher H Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eugene J Koay
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Christine Eyler
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew X Zhu
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
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Jun BG, Kim YD, Cheon GJ, Kim ES, Jwa E, Kim SG, Kim YS, Kim BS, Jeong SW, Jang JY, Lee SH, Kim HS. Clinical significance of radiation-induced liver disease after stereotactic body radiation therapy for hepatocellular carcinoma. Korean J Intern Med 2018; 33:1093-1102. [PMID: 28844122 PMCID: PMC6234411 DOI: 10.3904/kjim.2016.412] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/08/2017] [Accepted: 03/17/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS The aim of this study was to investigate parameters that predict radiation-induced liver disease (RILD) following stereotactic body radiotherapy (SBRT) in patients with hepatocellular carcinoma (HCC) and to identify the clinical significance of RILD. METHODS We retrospectively reviewed the medical records of 117 HCC patients who were treated by SBRT from March 2011 to February 2015. RILD was defined as elevated liver transaminases more than five times the upper normal limit or a worsening of Child-Pugh (CP) score by 2 within 3 months after SBRT. All patients were assessed at 1 month and every 3 months after SBRT. RESULTS Median follow-up was 22.5 months (range, 3 to 56) after SBRT. RILD was developed in 29 of the 117 patients (24.7%). On univariate analysis, significant predictive factors of RILD were pretreatment CP score (p < 0.001) and normal liver volume (p = 0.002). Multivariate analysis showed that CP score was a significant predictor of RILD (p < 0.001). The incidence of RILD increased above a CP score of 6 remarkably. The rate of recovery from RILD decreased significantly above a CP score of 8. Survival analysis showed that CP score was an independent prognostic factor of overall survival (p = 0.001). CONCLUSION CP score is a significant factor to predict RILD in patients with chronic liver disease. RILD can be tolerated by patients with a CP score ≤ 7. However, careful monitoring of liver function is needed for patients with a CP score 7 after SBRT.
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Affiliation(s)
- Baek Gyu Jun
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Young Don Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Gab Jin Cheon
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Eun Seog Kim
- Department of Radiation Oncology, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea
| | - Eunjin Jwa
- Department of Radiation Oncology, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Boo Sung Kim
- Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soon Chun Hyang University Seoul Hospital, Seoul, Korea
| | - Jae Young Jang
- Department of Internal Medicine, Soon Chun Hyang University Seoul Hospital, Seoul, Korea
| | - Sae Hwan Lee
- Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea
| | - Hong Soo Kim
- Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea
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14
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Jun BG, Kim YD, Kim SG, Kim YS, Jeong SW, Jang JY, Lee SH, Kim HS, Kang SH, Kim MY, Baik SK, Lee M, Kim TS, Choi DH, Choi SH, Suk KT, Kim DJ, Cheon GJ. Hepatitis B virus reactivation after radiotherapy for hepatocellular carcinoma and efficacy of antiviral treatment: A multicenter study. PLoS One 2018; 13:e0201316. [PMID: 30059513 PMCID: PMC6066246 DOI: 10.1371/journal.pone.0201316] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/12/2018] [Indexed: 02/06/2023] Open
Abstract
Convincing data that support routine use of preventive therapy against hepatitis B virus (HBV) reactivation in radiotherapy (RT) for hepatocellular carcinoma (HCC) are lacking. The aim of this study was to investigate the incidence, clinical significance, and risk factors of HBV reactivation after RT. Medical records of 133 HBsAg (+) HCC patients who received radiotherapy from March 2009 to February 2016 were reviewed. Patients were divided into two groups: 1) non-antiviral group, those who did not receive antiviral therapy before RT (n = 27); and antiviral group (those who underwent antiviral therapy before RT) (n = 106). Factors related to HBV reactivation in HCC patients were evaluated. 17 (12.7%) of 133 patients developed HBV reactivation after RT. Patients in the antiviral group had significantly lower rates of HBV reactivation than those in the non-antiviral group (7.5% vs. 33.3%, p<0.001). HBV related hepatitis was also lower in the antiviral group (3.8% vs. 14.8%, p = 0.031). In multivariate analysis, absence of antiviral treatment (OR: 8.339, 95% CI: 2.532-27.470, p<0.001) and combined treatment of RT with transarterial chemoembolizatoin (TACE) (OR: 5.313, 95% CI: 1.548-18.232, p = 0.008) were risk factors for HBV reactivation. HBV reactivation can occur after radiotherapy. Combination treatment of RT with TACE and non-antiviral treatment are major risk factors for HBV reactivation during or after RT. Therefore, preventive antiviral therapy should be recommended for patients with HCC who are scheduled to receive RT.
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Affiliation(s)
- Baek Gyu Jun
- Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea
| | - Young Don Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine Bucheon Hospital, Bucheon, South Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine Bucheon Hospital, Bucheon, South Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University College of Medicine Seoul Hospital, Seoul, South Korea
| | - Jae Young Jang
- Department of Internal Medicine, Soonchunhyang University College of Medicine Seoul Hospital, Seoul, South Korea
| | - Sae Hwan Lee
- Department of Internal Medicine, Soonchunhyang University College of Medicine Cheonan Hospital, Cheonan, South Korea
| | - Hong Soo Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine Cheonan Hospital, Cheonan, South Korea
| | - Seong Hee Kang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Moon Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Minjong Lee
- Department of Internal medicine, Kangwon National University Hospital, Chuncheon, South Korea
| | - Tae-Suk Kim
- Department of Internal medicine, Kangwon National University Hospital, Chuncheon, South Korea
| | - Dae Hee Choi
- Department of Internal medicine, Kangwon National University Hospital, Chuncheon, South Korea
| | - Sang-Hyeon Choi
- Department of Internal Medicine Hallym University College of Medicine, Chuncheon, South Korea
| | - Ki Tae Suk
- Department of Internal Medicine Hallym University College of Medicine, Chuncheon, South Korea
| | - Dong Joon Kim
- Department of Internal Medicine Hallym University College of Medicine, Chuncheon, South Korea
| | - Gab Jin Cheon
- Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea
- * E-mail:
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15
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Chan KT, Alessio AM, Johnson GE, Vaidya S, Kwan SW, Monsky W, Wilson AE, Lewis DH, Padia SA. Hepatotoxic Dose Thresholds by Positron-Emission Tomography After Yttrium-90 Radioembolization of Liver Tumors: A Prospective Single-Arm Observational Study. Cardiovasc Intervent Radiol 2018; 41:1363-1372. [PMID: 29651580 DOI: 10.1007/s00270-018-1949-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To define a threshold radiation dose to non-tumoral liver from 90Y radioembolization that results in hepatic toxicity using pair-production PET. MATERIALS AND METHODS This prospective single-arm study enrolled 35 patients undergoing radioembolization. A total of 34 patients (27 with HCC and 7 with liver metastases) were included in the final analysis. Of 27 patients with underlying cirrhosis, 22 and 5 patients were Child-Pugh A and B, respectively. Glass and resin microspheres were used in 32 (94%) and 2 (6%) patients, respectively. Lobar and segmental treatment was done in 26 (76%) and 8 (24%) patients, respectively. Volumetric analysis was performed on post-radioembolization time-of-flight PET imaging to determine non-tumoral parenchymal dose. Hepatic toxicity was evaluated up to 120 days post-treatment, with CTCAE grade ≤ 1 compared to grade ≥ 2. RESULTS The median dose delivered to the non-tumoral liver in the treated lobe was 49 Gy (range 0-133). A total of 15 patients had grade ≤ 1 hepatic toxicity, and 19 patients had grade ≥ 2 toxicity. Patients with a grade ≥ 2 change in composite toxicity (70.7 vs. 43.8 Gy), bilirubin (74.1 vs. 43.3 Gy), albumin (84.2 vs. 43.8 Gy), and AST (94.5 vs. 47.1 Gy) have significantly higher non-tumoral parenchymal doses than those with grade ≤ 1. Liver parenchymal dose and Child-Pugh status predicted grade ≥ 2 toxicity, observed above a dose threshold of 54 Gy. CONCLUSION Increasing delivered 90Y dose to non-tumoral liver measured by internal pair-production PET correlates with post-treatment hepatic toxicity. The likelihood of toxicity exceeds 50% at a dose threshold of 54 Gy. ClinicalTrials.gov identifier: NCT02848638.
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Affiliation(s)
- Keith T Chan
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 NE Pacific St., Box 357115, Seattle, WA, 98195-7115, USA
| | - Adam M Alessio
- Department of Radiology, University of Washington, 1959 NE Pacific St., Box 357115, Seattle, WA, 98195-7115, USA
| | - Guy E Johnson
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 NE Pacific St., Box 357115, Seattle, WA, 98195-7115, USA
| | - Sandeep Vaidya
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 NE Pacific St., Box 357115, Seattle, WA, 98195-7115, USA
| | - Sharon W Kwan
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 NE Pacific St., Box 357115, Seattle, WA, 98195-7115, USA
| | - Wayne Monsky
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 NE Pacific St., Box 357115, Seattle, WA, 98195-7115, USA
| | - Ann E Wilson
- Department of Radiology, University of Washington, 1959 NE Pacific St., Box 357115, Seattle, WA, 98195-7115, USA
| | - David H Lewis
- Division of Nuclear Medicine, Department of Radiology, Harborview Medical Center, 325 9th Ave, Seattle, WA, 98104, USA
| | - Siddharth A Padia
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095-7430, USA.
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16
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Son SH, Jang HS, Sung SY, Kang HJ, Lee S, Kay CS. Identifying the optimal criteria of radiotherapeutic parameters for patients with unresectable locally advanced hepatocellular carcinoma. Oncotarget 2016; 6:42372-9. [PMID: 26510905 PMCID: PMC4747233 DOI: 10.18632/oncotarget.5713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/05/2015] [Indexed: 12/26/2022] Open
Abstract
The purpose of this study is to identify the optimal criteria of the radiotherapeutic parameters in patients with unresectable locally advanced hepatocellular carcinoma (HCC). 103 patients were enrolled in this study. All patients received RT delivered using the TomoTherapy Hi-Art system between March 2006 and February 2012. We evaluated the planning target volume (PTV), total dose (Gy10), and NTNL-V(BED20) (non-target normal liver volume receiving more than a biologically effective dose of 20 Gy8) as significant radiotherapeutic parameters associated with hepatic function deterioration and local progression-free survival (PFS). A PTV of 279 cm3 or 304 cm3, a total dose of 60 Gy10, and a NTNL-V(BED20) of 40.8% were identified as the optimal cut-off values of radiotherapeutic parameters to prevent hepatic function deterioration and prolong local PFS. Based on these findings, patients were divided in a favorable and an unfavorable prognosis group. The differences in median local PFS, overall survival, and incidence of deteriorated hepatic function between the two groups were 11.2 months, 11.1 months, and 71.7%, respectively (p < 0.001 in each case). In conclusion, we suggest that the optimal criteria of the radiotherapeutic parameters for patients with unresectable locally advanced HCC are: PTV ≤ 279 cm3, total dose > 60 Gy10, and NTNL-V(BED20) ≤ 40.8%.
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Affiliation(s)
- Seok Hyun Son
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Seok Jang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Yoon Sung
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Jin Kang
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sojung Lee
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Seung Kay
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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17
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Vickress J, Lock M, Lo S, Gaede S, Leung A, Cao J, Barnett R, Yartsev S. A multivariable model to predict survival for patients with hepatic carcinoma or liver metastasis receiving radiotherapy. Future Oncol 2016; 13:19-30. [PMID: 27582002 DOI: 10.2217/fon-2016-0252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM New parameters that correlate with overall survival were identified in patients with liver lesions treated with radiation therapy. METHODS Pretreatment information and parameters of radiation treatment plans for 129 metastatic and 66 hepatocellular carcinoma liver cancer patients were analyzed. Study end points included overall survival collected from patient charts and electronic records. RESULTS Two practical nomograms were constructed for primary hepatocellular carcinoma and liver metastasis patients. For patients with a Child-Pugh A, radiation dose escalation provided a significant survival benefit. However, for those with Child-Pugh B or C, increasing dose does not impact on survival. CONCLUSION The developed models can potentially guide dose selection and provide prognostic information but still require external validation.
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Affiliation(s)
- Jason Vickress
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Michael Lock
- Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - Simon Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Stewart Gaede
- Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - Aaron Leung
- Department of Oncology, Western University, London, ON, Canada
| | - Jeff Cao
- Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - Rob Barnett
- Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - Slav Yartsev
- Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
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18
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Reducing the probability of radiation-induced hepatic toxicity by changing the treatment modality from helical tomotherapy to fixed-beam intensity-modulated radiotherapy. Oncotarget 2016; 6:33952-60. [PMID: 26376679 PMCID: PMC4741816 DOI: 10.18632/oncotarget.5581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/22/2015] [Indexed: 12/12/2022] Open
Abstract
Purpose To estimate and compare the risk of radiation-induced hepatic toxicity (RIHT) in helical tomotherapy and fixed-beam intensity-modulated radiotherapy (IMRT) for the treatment of hepatocellular carcinoma (HCC). Materials and Methods Twenty patients with unresectable HCC treated with tomotherapy were selected. We performed tomotherapy re-planning to reduce the non-target normal liver volume receiving a dose of more than 15 Gy (NTNL-V15Gy), and we created a fixed-beam IMRT plan (FB-P). We compared the dosimetric results as well as the estimated probability of RIHT among the tomotherapy initial plan (T-IP), the tomotherapy re-plan (T-RP), and the FB-P. Results Comparing the T-RP and FB-P, the homogeneity index was 0.11 better with the T-RP. However, the mean NTNL-V15Gy was 6.3% lower with the FB-P. These differences result in a decline in the probability of RIHT from 0.216 in the T-RP to 0.115 in the FB-P. In patients whose NTNL-V15Gy was higher than 43.2% with the T-RP, the probability of RIHT markedly reduced from 0.533 to 0.274. Conclusions By changing the treatment modality from tomotherapy to fixed-beam IMRT, we could reduce the liver dose and the probability of RIHT without scarifying the target coverage, especially in patients whose liver dose is high.
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19
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Bae BK, Kim JC. The response of thrombosis in the portal vein or hepatic vein in hepatocellular carcinoma to radiation therapy. Radiat Oncol J 2016; 34:168-176. [PMID: 27545294 PMCID: PMC5066450 DOI: 10.3857/roj.2016.01669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/23/2016] [Accepted: 06/21/2016] [Indexed: 12/19/2022] Open
Abstract
Purpose The purpose of current study is to evaluate the response of the patients with portal vein thrombosis (PVT) or hepatic vein thrombosis (HVT) in hepatocellular carcinoma (HCC) treated with three-dimensional conformal radiation therapy (3D-CRT). In addition, survival of patients and potential prognostic factors of the survival was evaluated. Materials and Methods Forty-seven patients with PVT or HVT in HCC, referred to our department for radiotherapy, were retrospectively reviewed. For 3D-CRT plans, a gross tumor volume (GTV) was defined as a hypodense filling defect area in the portal vein (PV) or hepatic vein (HV). Survival of patients, and response to radiation therapy (RT) were analyzed. Potential prognostic factors for survival and response to RT were evaluated. Results The median survival time of 47 patients was 8 months, with 1-year survival rate of 15% and response rate of 40%. Changes in Child-Pugh score, response to RT, Eastern cooperative oncology group performance status (ECOG PS), hepatitis C antibody (HCVAb) positivity, and additional post RT treatment were statistically significant prognostic factors for survival in univariate analysis (p = 0.000, p = 0.018, p = 0.000, p = 0.013, and p = 0.047, respectively). Of these factors, changes in Child-Pugh score, and response to RT were significant for patients’ prognosis in multivariate analysis (p = 0.001 and p = 0.035, respectively). Conclusion RT could constitute a reasonable treatment option for patients with PVT or HVT in HCC with acceptable toxicity. Changes in Child-Pugh score, and response to RT were statistically significant factors of survival of patients.
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Affiliation(s)
- Bong Kyung Bae
- Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae-Chul Kim
- Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea
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20
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Gabrielson A, Miller A, Banovac F, Kim A, He AR, Unger K. Outcomes and Predictors of Toxicity after Selective Internal Radiation Therapy Using Yttrium-90 Resin Microspheres for Unresectable Hepatocellular Carcinoma. Front Oncol 2015; 5:292. [PMID: 26779437 PMCID: PMC4688348 DOI: 10.3389/fonc.2015.00292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/07/2015] [Indexed: 02/01/2023] Open
Abstract
Purpose We sought to report outcomes and toxicity in patients with hepatocellular carcinoma (HCC) who received resin yttrium-90 selective internal radiation therapy (90Y-SIRT) and to identify factors associated with declining liver function. Methods Patients treated with 90Y-SIRT were retrospectively evaluated. Radiographic response was assessed using RECIST 1.1. Median liver progression-free survival (LPFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Bivariate analysis was used to examine associations between change in Child-Pugh (CP) score/class and patient characteristics and treatment parameters. Results Twenty-seven patients with unresectable HCC underwent SIRT, 52% were CP Class A, 48% were Class B, 11% were BCLC stage B, and 89% were stage C. Forty-four percent of patients had portal vein thrombus at baseline. One-third of patients received bilobar treatment. Median activity was 32.1 mCi (range 9.18–43.25) and median-absorbed dose to the liver was 39.6 Gy (range 13.54–67.70). Median LPFS and OS were 2.5 and 11.7 months, respectively. Three-month disease control rate was 63 and 52% in the target lesions and whole liver, respectively. New onset or worsened from baseline clinical toxicities were confined to Grade 1–2 events. However, new or worsened Grade 3–4 laboratory toxicities occurred in 38% of patients at 3 months and 43% of patients at 6 months following SIRT (six had lymphocytopenia, three had hypoalbuminemia, and two had transaminasemia). After 3 months, six patients had worsened in CP score and five had worsened in class from baseline. After 6 months, four patients had worsened in CP score and one had worsened in class from baseline. Pretreatment bilirubinemia was associated with a 2+ increase in CP score within 3 months (P = 0.001) and 6 months (P = 0.039) of 90Y-SIRT. Pretreatment transaminasemia and bilirubinemia were associated with increased CP class within 3 months of SIRT (P = 0.021 and 0.009, respectively). Conclusion 90Y-SIRT was well-tolerated in patients with unresectable HCC, with no Grade 3–4 clinical toxicities. However, Grade 3–4 laboratory toxicities and worsened CP scores were more frequent. HCC patients with pretreatment bilirubinemia or transaminasemia may be at higher risk of experiencing a decline in liver function following 90Y-SIRT.
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Affiliation(s)
- Andrew Gabrielson
- Division of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital , Washington, DC , USA
| | - Akemi Miller
- Department of Interventional Radiology, Georgetown University Hospital , Washington, DC , USA
| | - Filip Banovac
- Department of Interventional Radiology, Georgetown University Hospital , Washington, DC , USA
| | - Alexander Kim
- Department of Interventional Radiology, Georgetown University Hospital , Washington, DC , USA
| | - Aiwu Ruth He
- Division of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital , Washington, DC , USA
| | - Keith Unger
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
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21
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Hong TS, Wo JY, Yeap BY, Ben-Josef E, McDonnell EI, Blaszkowsky LS, Kwak EL, Allen JN, Clark JW, Goyal L, Murphy JE, Javle MM, Wolfgang JA, Drapek LC, Arellano RS, Mamon HJ, Mullen JT, Yoon SS, Tanabe KK, Ferrone CR, Ryan DP, DeLaney TF, Crane CH, Zhu AX. Multi-Institutional Phase II Study of High-Dose Hypofractionated Proton Beam Therapy in Patients With Localized, Unresectable Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma. J Clin Oncol 2015; 34:460-8. [PMID: 26668346 DOI: 10.1200/jco.2015.64.2710] [Citation(s) in RCA: 302] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of high-dose, hypofractionated proton beam therapy for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). MATERIALS AND METHODS In this single-arm, phase II, multi-institutional study, 92 patients with biopsy-confirmed HCC or ICC, determined to be unresectable by multidisciplinary review, with a Child-Turcotte-Pugh score (CTP) of A or B, ECOG performance status of 0 to 2, no extrahepatic disease, and no prior radiation received 15 fractions of proton therapy to a maximum total dose of 67.5 Gy equivalent. Sample size was calculated to demonstrate > 80% local control (LC) defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.0 criteria at 2 years for HCC patients, with the parallel goal of obtaining acceptable precision for estimating outcomes for ICC. RESULTS Eighty-three patients were evaluable: 44 with HCC, 37 with ICC, and two with mixed HCC/ICC. The CTP score was A for 79.5% of patients and B for 15.7%; 4.8% of patients had no cirrhosis. Prior treatment had been given to 31.8% of HCC patients and 61.5% of ICC patients. The median maximum dimension was 5.0 cm (range, 1.9 to 12.0 cm) for HCC patients and 6.0 cm (range, 2.2 to 10.9 cm) for ICC patients. Multiple tumors were present in 27.3% of HCC patients and in 12.8% of ICC patients. Tumor vascular thrombosis was present in 29.5% of HCC patients and in 28.2% of ICC patients. The median dose delivered to both HCC and ICC patients was 58.0 Gy. With a median follow-up among survivors of 19.5 months, the LC rate at 2 years was 94.8% for HCC and 94.1% for ICC. The overall survival rate at 2 years was 63.2% for HCC and 46.5% ICC. CONCLUSION High-dose hypofractionated proton therapy demonstrated high LC rates for HCC and ICC safely, supporting ongoing phase III trials of radiation in HCC and ICC.
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Affiliation(s)
- Theodore S Hong
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Jennifer Y Wo
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Beow Y Yeap
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edgar Ben-Josef
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erin I McDonnell
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lawrence S Blaszkowsky
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eunice L Kwak
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jill N Allen
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey W Clark
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lipika Goyal
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Janet E Murphy
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Milind M Javle
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John A Wolfgang
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lorraine C Drapek
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ronald S Arellano
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Harvey J Mamon
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John T Mullen
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sam S Yoon
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kenneth K Tanabe
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cristina R Ferrone
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - David P Ryan
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas F DeLaney
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher H Crane
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrew X Zhu
- Theodore S. Hong, Jennifer Y. Wo, Beow Y. Yeap, Erin I. McDonnell, Lawrence S. Blaszkowsky, Eunice L. Kwak, Jill N. Allen, Jeffrey W. Clark, Lipika Goyal, Janet E. Murphy, John A. Wolfgang, Lorraine C. Drapek, Ronald S. Arellano, John T. Mullen, Sam S. Yoon, Kenneth K. Tanabe, Cristina R. Ferrone, David P. Ryan, Thomas F. DeLaney, and Andrew X. Zhu, Massachusetts General Hospital, Harvard Medical School; Harvey J. Mamon, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Edgar Ben-Josef, University of Pennsylvania Hospital, Philadelphia, PA; and Milind M. Javle and Christopher H. Crane, University of Texas MD Anderson Cancer Center, Houston, TX
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Song JH, Son SH, Kay CS, Jang HS. Identification of Biologically Effective Dose-Volumetric Parameters That Predict Radiation-Induced Hepatic Toxicity in Patients Treated With Helical Tomotherapy for Unresectable Locally Advanced Hepatocellular Carcinoma. Medicine (Baltimore) 2015; 94:e1904. [PMID: 26512611 PMCID: PMC4985424 DOI: 10.1097/md.0000000000001904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study is to identify dose-volumetric parameters that predict radiation-induced hepatic toxicity (RIHT) by analyzing the relationship between the biologically effective dose (BED) delivered to the normal liver and RIHT.The clinical and dosimetric data from 123 patients with unresectable hepatocellular carcinoma (HCC) treated with helical tomotherapy were analyzed. The median radiation dose was a 50 Gy in 4.5 Gy fractions (range, 30-60 Gy in 1.8-5.0 Gy fractions) to 95% of the planning target volume. RIHT was defined as a Child-Pugh score increase of at least 2 points within 3 months of helical tomotherapy completion.RIHT developed in 60 patients (48.7%). Multivariate logistic regression analysis showed that VBED20 (percentage of nontarget normal liver volume that received more than a BED of 20 Gy) was a significant parameter (P < 0.001), and the cut-off value was 40.8% with a sensitivity and specificity of 0.833 and 0.698, respectively, according to the receiver operating characteristic curve (P < 0.001).Maintaining a VBED20 below 40.8% will reduce the risk of RIHT, and the proposed normal liver tolerance curve could be a useful guideline when treating unresectable HCC patients with various radiotherapy dose schedules.
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Affiliation(s)
- Jin Ho Song
- From the Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju (JHS); Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea (SHS, CSK); and Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (HSJ)
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