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Wen C, Tian Z, Li L, Chen T, Chen H, Dai J, Liang Z, Ma S, Liu X. SRSF3 and HNRNPH1 Regulate Radiation-Induced Alternative Splicing of Protein Arginine Methyltransferase 5 in Hepatocellular Carcinoma. Int J Mol Sci 2022; 23:ijms232314832. [PMID: 36499164 PMCID: PMC9738276 DOI: 10.3390/ijms232314832] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
Protein arginine methyltransferase 5 (PRMT5) is an epigenetic regulator which has been proven to be a potential target for cancer therapy. We observed that PRMT5 underwent alternative splicing (AS) and generated a spliced isoform PRMT5-ISO5 in hepatocellular carcinoma (HCC) patients after radiotherapy. However, the regulatory mechanism and the clinical implications of IR-induced PRMT5 AS are unclear. This work revealed that serine and arginine rich splicing factor 3 (SRSF3) silencing increased PRMT5-ISO5 level, whereas heterogeneous nuclear ribonucleoprotein H 1 (HNRNPH1) silencing reduced it. Then, we found that SRSF3 and HNRNPH1 competitively combined with PRMT5 pre-mRNA located at the region around the 3'- splicing site on intron 2 and the alternative 3'- splicing site on exon 4. IR-induced SRSF3 downregulation led to an elevated level of PRMT5-ISO5, and exogenous expression of PRMT5-ISO5 enhanced cell radiosensitivity. Finally, we confirmed in vivo that IR induced the increased level of PRMT5-ISO5 which in turn enhanced tumor killing and regression, and liver-specific Prmt5 depletion reduced hepatic steatosis and delayed tumor progression of spontaneous HCC. In conclusion, our data uncover the competitive antagonistic interaction of SRSF3 and HNRNPH1 in regulating PRMT5 splicing induced by IR, providing potentially effective radiotherapy by modulating PRMT5 splicing against HCC.
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Affiliation(s)
- Chaowei Wen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, China
| | - Zhujun Tian
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China
| | - Lan Li
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China
| | - Tongke Chen
- Laboratory Animal Center, Wenzhou Medical University, Wenzhou 325035, China
| | - Huajian Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China
| | - Jichen Dai
- School of the 2nd Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Zhenzhen Liang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China
- NHC Key Laboratory of Radiobiology, School of Public Health, Jilin University, Changchun 130021, China
| | - Shumei Ma
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China
- South Zhejiang Institute of Radiation Medicine and Nuclear Technology, Wenzhou 325014, China
| | - Xiaodong Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China
- South Zhejiang Institute of Radiation Medicine and Nuclear Technology, Wenzhou 325014, China
- Key Laboratory of Watershed Science and Health of Zhejiang Province, Wenzhou 325035, China
- Correspondence:
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Loo KF, Woodman RJ, Bogatic D, Chandran V, Muller K, Chinnaratha MA, Bate J, Campbell K, Maddison M, Narayana S, Le H, Pryor D, Wigg A. High rates of treatment stage migration for early hepatocellular carcinoma and association with adverse outcomes: An Australian multicenter study. JGH Open 2022; 6:599-606. [PMID: 36091321 PMCID: PMC9446396 DOI: 10.1002/jgh3.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Kee Fong Loo
- Hepatology and Liver Transplant Medicine Unit Southern Adelaide Local Health Network Adelaide South Australia Australia
- College of Medicine and Public Health Flinders University Adelaide South Australia Australia
| | - Richard J Woodman
- College of Medicine and Public Health Flinders University Adelaide South Australia Australia
| | - Damjana Bogatic
- Department of Medicine Royal Adelaide Hospital Adelaide South Australia Australia
| | - Vidyaleha Chandran
- Department of Gastroenterology and Hepatology Lyell McEwin Hospital Adelaide South Australia Australia
| | - Kate Muller
- Hepatology and Liver Transplant Medicine Unit Southern Adelaide Local Health Network Adelaide South Australia Australia
- College of Medicine and Public Health Flinders University Adelaide South Australia Australia
| | - Mohamed Asif Chinnaratha
- Department of Gastroenterology and Hepatology Lyell McEwin Hospital Adelaide South Australia Australia
- Faculty of Health and Medical Sciences The University of Adelaide Adelaide South Australia Australia
| | - John Bate
- Department of Gastroenterology and Hepatology Royal Adelaide Hospital Adelaide South Australia Australia
| | - Kirsty Campbell
- Department of Gastroenterology and Hepatology Royal Darwin Hospital Darwin Northern Territory Australia
| | - Matthew Maddison
- Department of Gastroenterology and Hepatology Royal Darwin Hospital Darwin Northern Territory Australia
| | - Sumudu Narayana
- Hepatology and Liver Transplant Medicine Unit Southern Adelaide Local Health Network Adelaide South Australia Australia
| | - Hien Le
- Department of Radiation Oncology Royal Adelaide Hospital Adelaide South Australia Australia
- The University of South Australia Adelaide South Australia Australia
| | - David Pryor
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia
- Queensland University of Technology Brisbane Queensland Australia
| | - Alan Wigg
- Hepatology and Liver Transplant Medicine Unit Southern Adelaide Local Health Network Adelaide South Australia Australia
- College of Medicine and Public Health Flinders University Adelaide South Australia Australia
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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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Sun J, Li WG, Wang Q, He WP, Wang HB, Han P, Zhang T, Zhang AM, Fan YZ, Sun YZ, Duan XZ. Hepatic Resection Versus Stereotactic Body Radiation Therapy Plus Transhepatic Arterial Chemoembolization for Large Hepatocellular Carcinoma: A Propensity Score Analysis. J Clin Transl Hepatol 2021; 9:672-681. [PMID: 34722182 PMCID: PMC8516846 DOI: 10.14218/jcth.2020.00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/13/2021] [Accepted: 04/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND AIMS There are no comparative studies on the efficacy of hepatic resection (HR) and CyberKnife stereotactic body radiation therapy (CK-SBRT) plus transhepatic arterial chemotherapy embolization (TACE) in the treatment of large hepatocellular carcinoma (HCC). Therefore, this study aimed to compare the efficacy of HR and CK-SBRT+TACE in large HCC. METHODS A total of one hundred and sixteen patients were selected from November 2011 to December 2016. Among them, 50 were allocated to the CK-SBRT+TACE group and 66 were allocated to the HR group. The Kaplan-Meier method was applied to calculate overall survival (OS) and progression-free survival (PFS) rates. Propensity score matching was performed to control for baseline differences between the groups. RESULTS Thirty-six paired patients were selected from the CK-SBRT+TACE and HR groups. After propensity score matching, the 1-, 2- and 3-year OS rates were 83.3%, 77.8% and 66.7% in the HR group and 80.6%, 72.2% and 52.8% in the CK-SBRT+TACE group, respectively. The 1-, 2- and 3-year PFS rates were 71.6%, 57.3% and 42.3% in the HR group and 66.1%, 45.8% and 39.3% in the CK-SBRT+TACE group, respectively (OS: p=0.143; PFS: p=0.445). Both a high platelet count and low alpha-fetoprotein value were revealed as influencing factors in improving OS and PFS. CONCLUSIONS CK-SBRT+TACE brought local effects that were similar to those of HR in HCC patients with a large and single lesion. Moreover, the liver injury occurrence rate was acceptable in both groups.
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Affiliation(s)
- Jing Sun
- Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wen-Gang Li
- Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Quan Wang
- Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wei-Ping He
- Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hong-Bo Wang
- Department of Hepatic Surgery, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Han
- Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tao Zhang
- Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ai-Min Zhang
- Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yu-Ze Fan
- Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ying-Zhe Sun
- Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xue-Zhang Duan
- Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Correspondence to: Xue-Zhang Duan, Radiation Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing 100039, China. ORCID: https://orcid.org/0000-0002-1941-9317. Tel: +86-13621386161, E-mail:
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Cantaloube M, Castan F, Creoff M, Prunaretty J, Bordeau K, Michalet M, Assenat E, Guiu B, Pageaux GP, Ychou M, Aillères N, Fenoglietto P, Azria D, Riou O. Image-Guided Liver Stereotactic Body Radiotherapy Using VMAT and Real-Time Adaptive Tumor Gating: Evaluation of the Efficacy and Toxicity for Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13194853. [PMID: 34638336 PMCID: PMC8507769 DOI: 10.3390/cancers13194853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Although the use of stereotactic body radiation therapy (SBRT) in the management of hepatocellular carcinoma (HCC) remains unclear, it is a therapeutic option often considered in patients not eligible to or recurring after other local therapies. Liver SBRT can be delivered using a wide range of techniques and linear accelerators. We report the first evaluation for HCC of SBRT using volumetric modulated arc therapy (VMAT) and real-time adaptive tumor gating, which is a mainly completely non-invasive procedure (no fiducial markers for 65.2% of the patients). Our study showed that this SBRT technique has very favorable outcomes with optimal local control and a low toxicity rate. Abstract Liver SBRT is a therapeutic option for the treatment of HCC in patients not eligible for other local therapies. We retrospectively report the outcomes of a cohort of consecutive patients treated with SBRT for HCC at the Montpellier Cancer Institute. Between March 2013 and December 2018, 66 patients were treated with image-guided liver SBRT using VMAT and real-time adaptive tumor gating in our institute. The main endpoints considered in this study were local control, disease-free survival, overall survival, and toxicity. The median follow-up was 16.8 months. About 66.7% had prior liver treatment. Most patients received 50 Gy in five fractions of 10 Gy. No patient had local recurrence. Overall survival and disease-free survival were, respectively, 83.9% and 46.7% at one year. In multivariate analysis, the diameter of the lesions was a significant prognostic factor associated with disease-free survival (HR = 2.57 (1.19–5.53) p = 0.02). Regarding overall survival, the volume of PTV was associated with lower overall survival (HR = 2.84 (1.14–7.08) p = 0.025). No grade 3 toxicity was observed. One patient developed a grade 4 gastric ulcer, despite the dose constraints being respected. Image-guided liver SBRT with VMAT is an effective and safe treatment in patients with inoperable HCC, even in heavily pre-treated patients. Further prospective evaluation will help to clarify the role of SBRT in the management of HCC patients.
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Affiliation(s)
- Marie Cantaloube
- Montpellier Cancer Institute (ICM), University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier University, INSERM U1194 IRCM, 34298 Montpellier, France; (M.C.); (M.C.); (J.P.); (K.B.); (M.M.); (N.A.); (P.F.); (D.A.)
| | - Florence Castan
- Biometrics Unit ICM, Montpellier Cancer Institute, University Montpellier, 34298 Montpellier, France;
| | - Morgane Creoff
- Montpellier Cancer Institute (ICM), University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier University, INSERM U1194 IRCM, 34298 Montpellier, France; (M.C.); (M.C.); (J.P.); (K.B.); (M.M.); (N.A.); (P.F.); (D.A.)
- Oncodoc, 34500 Béziers, France
| | - Jessica Prunaretty
- Montpellier Cancer Institute (ICM), University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier University, INSERM U1194 IRCM, 34298 Montpellier, France; (M.C.); (M.C.); (J.P.); (K.B.); (M.M.); (N.A.); (P.F.); (D.A.)
| | - Karl Bordeau
- Montpellier Cancer Institute (ICM), University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier University, INSERM U1194 IRCM, 34298 Montpellier, France; (M.C.); (M.C.); (J.P.); (K.B.); (M.M.); (N.A.); (P.F.); (D.A.)
| | - Morgan Michalet
- Montpellier Cancer Institute (ICM), University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier University, INSERM U1194 IRCM, 34298 Montpellier, France; (M.C.); (M.C.); (J.P.); (K.B.); (M.M.); (N.A.); (P.F.); (D.A.)
| | - Eric Assenat
- Service d’Oncologie Médicale, CHU St Eloi, 34000 Montpellier, France;
| | - Boris Guiu
- Imagerie Médicale St Eloi, 34000 Montpellier, France;
| | | | - Marc Ychou
- Medical Oncology Department, Montpellier Cancer Institute (ICM), Montpellier University, INSERM U1194 IRCM, 34298 Montpellier, France;
| | - Norbert Aillères
- Montpellier Cancer Institute (ICM), University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier University, INSERM U1194 IRCM, 34298 Montpellier, France; (M.C.); (M.C.); (J.P.); (K.B.); (M.M.); (N.A.); (P.F.); (D.A.)
| | - Pascal Fenoglietto
- Montpellier Cancer Institute (ICM), University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier University, INSERM U1194 IRCM, 34298 Montpellier, France; (M.C.); (M.C.); (J.P.); (K.B.); (M.M.); (N.A.); (P.F.); (D.A.)
| | - David Azria
- Montpellier Cancer Institute (ICM), University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier University, INSERM U1194 IRCM, 34298 Montpellier, France; (M.C.); (M.C.); (J.P.); (K.B.); (M.M.); (N.A.); (P.F.); (D.A.)
| | - Olivier Riou
- Montpellier Cancer Institute (ICM), University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier University, INSERM U1194 IRCM, 34298 Montpellier, France; (M.C.); (M.C.); (J.P.); (K.B.); (M.M.); (N.A.); (P.F.); (D.A.)
- Correspondence:
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Shanker MD, Moodaley P, Soon W, Liu HY, Lee YY, Pryor DI. Stereotactic ablative radiotherapy for hepatocellular carcinoma: A systematic review and meta-analysis of local control, survival and toxicity outcomes. J Med Imaging Radiat Oncol 2021; 65:956-968. [PMID: 34396706 DOI: 10.1111/1754-9485.13309] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022]
Abstract
There is a growing body of literature supporting the use of stereotactic ablative body radiotherapy (SABR) in the management of primary hepatocellular carcinoma (HCC). This systematic review and meta-analysis of the current published evidence for SABR for HCC assessed the impact of treatment dose, fractionation and tumour size on the outcomes of local control (LC), overall survival (OS) and toxicity. A systematic search was independently performed by two authors for articles published in peer-reviewed journals between January 2005 and December 2019. A DerSimonian and Laird random effects model was used to assess pooled results. A multivariate meta-regression analysis incorporated the effect of explanatory variables (radiation dose in EQD2[10], fractionation and tumour size) on outcomes of OS, LC and toxicity. Forty-nine cohorts involving 2846 HCC patients with 3088 lesions treated with SABR were included. Pooled 1-, 2- and 3-year LC rates were 91.1% (95% confidence interval [CI] 88.3-93.2), 86.7% (95% CI 82.7-89.8) and 84.2% (95% CI 77.9-88.9) respectively. Pooled 1-, 2- and 3-year OS rates were 78.4% (95% CI 73.4-82.6), 61.3% (55.2-66.9) and 48.3% (95% CI 39.0-57). Population-weighted median grade 3 toxicity rates were 6.5% (IQR 3.2-16) and mean grade 4/5 rates were 1.4% (IQR 0-2.1). Within EQD2[10] ranges of 40 to 83.33 Gy corresponding to common dose-fractionation regimens of 30-50 Gy in 5 fractions, there was a multivariate association between superior LC and OS with increasing EQD2[10] , with a proportionately smaller increase in grade 3 toxicity and no association with grade 4/5 toxicity. Stereotactic ablative body radiotherapy is a viable treatment option for HCC with high LC rates and low rates of reported grade 3/4 toxicity. Increasing EQD2[10] was associated with improvements in LC and OS with a comparatively smaller increase in toxicity. Prospective randomised trials are warranted to define optimal patient selection and dose-fractionation regimens.
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Affiliation(s)
- Mihir D Shanker
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Pereshin Moodaley
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Wei Soon
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Howard Y Liu
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Yoo Young Lee
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - David I Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Zhang Y, He X, Guo W, Sun L, Guo C, Feng Y. CT‐guided liver beacon transponder implantation. PRECISION MEDICAL SCIENCES 2021. [DOI: 10.1002/prm2.12033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yufeng Zhang
- Department of Radiotherapy Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Xia He
- Department of Radiotherapy Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Wenjie Guo
- Department of Radiotherapy Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Li Sun
- Department of Radiotherapy Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Chang Guo
- Department of Radiotherapy Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Yong Feng
- Department of Radiotherapy Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
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Sun J, Zhang A, Li W, Wang Q, Wang J, Fan Y, Sun Y, Li D, Zhang D, Duan X. CyberKnife Stereotactic Body Radiation Therapy as an Effective Treatment for Hepatocellular Carcinoma Patients With Decompensated Cirrhosis. Front Oncol 2020; 10:100. [PMID: 32158688 PMCID: PMC7052044 DOI: 10.3389/fonc.2020.00100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose: The aim of our study was to evaluate the curative effect and safety of CyberKnife stereotactic body radiation therapy in treating decompensated cirrhosis hepatocellular carcinoma (HCC) patients. Methods: From March 2011 to December 2015, 32 HCC patients who refused or were ineligible for other treatments were treated with CyberKnife stereotactic body radiation therapy. Among these patients, 17 were Child-Pugh score 7 (53.13%), 7 were Child-Pugh score 8 (21.87%), 4 were Child-Pugh score 9 (12.50%), and 4 were Child-Pugh score 10 (12.50%). A total dose of 45-54 Gy in 5-10 fractions was given according to the location of lesions. Results: The median follow-up period was 30 months (8-46 months). By July 2019, the tumors were recurrent or metastasized in 17 patients. The overall survival rates of 1, 2, and 3 years were 84.4, 61.8, and 46.0%, respectively. After 1, 2, and 3 years, the local control rates were 92.9%. The progression-free survival rates of the 1, 2, and 3-year treatments were 73.8, 44.6, and 33.4%, respectively. Conclusions: CyberKnife stereotactic body radiation therapy was an effective option for HCC patients with decompensated cirrhosis. The liver injury occurrence rate was acceptable in our study.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xuezhang Duan
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), Beijing, China
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Sun J, Zhang A, Li W, Wang Q, Li D, Zhang D, Duan X. Biologically effective dose (BED) escalation of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma patients (≤5 cm) with CyberKnife: protocol of study. Radiat Oncol 2020; 15:20. [PMID: 31992327 PMCID: PMC6986016 DOI: 10.1186/s13014-020-1471-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/15/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is a lack of data on the biologically effective dose and the efficacy of stereotactic body radiotherapy in hepatocellular carcinoma patients, and this study was conducted to explore the relation between BED and efficacy. METHODS This study is designed as a mono-center study. The participants are randomized into three group, and received the following recommended schedule: 49Gy/7f, 54Gy/6f and 55Gy/5f with BED10 in correspondence to 83.3Gy, 102.6Gy and 115.5Gy. The primary outcome measures are to calculate local control rates (LC), overall survival rates (OS) and progression-free survival rates (PFS). The secondary outcome measures are to observe radiation-induced liver injury (RILD) rates, Child-Pugh score and indocyanine green retention rate at 15 min (ICG-R15) value before and after CK-SBRT. Moreover, gastrointestinal toxicities are also observed. DISCUSSION There is no uniform standard for CK-SBRT dose schedule of hepatocellular carcinoma. We propose to conduct a study determining the optimal CK-SBRT schedule of hepatocellular carcinoma patients (≤5 cm). The trial protocol has been approved by the Institutional Review Board of 302 Hospital of PLA (People's Liberation Army). The Ethics number is 2017111D. TRAIL REGISTRATION Clinical trails number: NCT03295500. Date of registration: November, 2017.
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Affiliation(s)
- Jing Sun
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039, China
| | - Aimin Zhang
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039, China
| | - Wengang Li
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039, China
| | - Quan Wang
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039, China
| | - Dong Li
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039, China
| | - Dan Zhang
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039, China
| | - Xuezhang Duan
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039, China.
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Sun J, Ouyang C, Chang X, Zhang A, Wang Q, Li W, Zhang D, Wang J, Li D, Duan X. Repeated CyberKnife stereotactic body radiation therapy in hepatocellular carcinoma. Radiat Oncol 2020; 15:10. [PMID: 31918728 PMCID: PMC6953301 DOI: 10.1186/s13014-020-1457-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background To explore the survival and side effects of repeated CyberKnife stereotactic body radiation therapy (CK-SBRT) on hepatocellular carcinoma patients. Methods 24 HCC patients were collected at The Fifth Medical Center of PLA General Hospital from November 2011 to July 2016. They received second-course CK-SBRT with a prescribed dose of 50(48–55) Gy/5-8fx, and a single dose of 10 (7–11) Gy/fx. Cumulative overall survival rates (OS), progression-free survival rates (PFS) and local control rates (LC) were calculated by Kaplan-Meier method. Results All patients finished their radiotherapy plans. The 1-,2- and 3-year cumulative OS rate were 95.8,81.1 and 60.8%. The 1-,2- and 3-year LC rate were 95.5,90.7 and 90.7%, respectively. The 1-, 2- and 3-year PFS were 74.8, 49.2 and 39.4%, respectively. 16 patients complained of fatigue during second-course therapy, 2 patients showed Grade 2 gastrointestinal reaction, 1 patient was diagnosed radiation-induced liver disease and none died. PFS was significantly higher in the interval time < 12 months group than in the interval time ≥ 12 months group (p = 0.030). Conclusions It is preliminarily believed that re-CK-SBRT is an effective and safe treatment for HCC patients, but the treatment criteria should be strictly controlled.
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Affiliation(s)
- Jing Sun
- Department of Radiation Oncology, The Fifth Medical Center of PLA General Hospital (302 Military Hospital), Beijing, 100039, China
| | - Can Ouyang
- Department of Radiation Oncology, The Fifth Medical Center of PLA General Hospital (302 Military Hospital), Beijing, 100039, China
| | - Xiaoyun Chang
- Department of Radiation Oncology, The Fifth Medical Center of PLA General Hospital (302 Military Hospital), Beijing, 100039, China
| | - Aimin Zhang
- Department of Radiation Oncology, The Fifth Medical Center of PLA General Hospital (302 Military Hospital), Beijing, 100039, China
| | - Quan Wang
- Department of Radiation Oncology, The Fifth Medical Center of PLA General Hospital (302 Military Hospital), Beijing, 100039, China
| | - Wengang Li
- Department of Radiation Oncology, The Fifth Medical Center of PLA General Hospital (302 Military Hospital), Beijing, 100039, China
| | - Dan Zhang
- Department of Radiation Oncology, The Fifth Medical Center of PLA General Hospital (302 Military Hospital), Beijing, 100039, China
| | - Jia Wang
- Department of Radiation Oncology, The Fifth Medical Center of PLA General Hospital (302 Military Hospital), Beijing, 100039, China
| | - Dong Li
- Department of Radiation Oncology, The Fifth Medical Center of PLA General Hospital (302 Military Hospital), Beijing, 100039, China
| | - Xuezhang Duan
- Department of Radiation Oncology, The Fifth Medical Center of PLA General Hospital (302 Military Hospital), Beijing, 100039, China.
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Zhuang Y, Yuan BY, Chen GW, Zhao XM, Hu Y, Zhu WC, Zeng ZC, Chen YX. Association Between Circulating Lymphocyte Populations and Outcome After Stereotactic Body Radiation Therapy in Patients With Hepatocellular Carcinoma. Front Oncol 2019; 9:896. [PMID: 31552194 PMCID: PMC6748162 DOI: 10.3389/fonc.2019.00896] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/28/2019] [Indexed: 12/28/2022] Open
Abstract
Background and Objective: Radiation-induced lymphopenia has a tangible impact on overall survival (OS) in multiple solid tumors. We investigated the association between circulating lymphocyte populations (CLPs) before and after stereotactic body radiation therapy (SBRT) and OS in patients with hepatocellular carcinoma (HCC). Materials and Methods: Seventy-eight HCC patients treated with SBRT between January 2013 and June 2017 were retrospectively analyzed. Baseline and post-treatment total peripheral lymphocyte counts (TPLCs) and values of different CLPs were obtained and analyzed for clinical outcomes. Univariate and multivariate Cox regression analyses were used to explore the independent prognostic factors for patient survival. Results: The one-, two- and three-year OS rates were 94.8, 75.9, and 63.3%, respectively. The mean TPLCs before and 10 days after SBRT were 1.4 × 109/L and 0.7 × 109/L, respectively. The TPLC recovered to its baseline value 1 year after SBRT. Multivariate analysis results revealed that variables, including tumor necrosis factor-alpha (TNF-α) level <5.5 ng/mL and post-treatment TPLC <0.45 × 109/L were independent factors for inferior OS. Further analysis showed that the values of CLPs, including CD3+, CD4+, CD8+, CD19+, and CD16+56+ cells dropped profoundly 10 days after SBRT, among which CD19+ B cell count was mostly depleted and gradually recovered after 2 months. Univariate analysis showed that both baseline and post-treatment TPLC and CLP (except post-treatment B cell) counts were significantly associated with patient OS (p < 0.05 for each). Further stratified analysis performed according to OS at 2 years demonstrated that the CD16+CD56+ NK cell counts remained significantly elevated in patients with better survival (OS > 2 years) compared to those in short-term survivors at 10 days, 1 month, and 2 months after SBRT (p < 0.05 for each). In addition, there were significant differences in TPLC and CD8+ T cell counts in patients with long-term and short-term OS at 2 months after SBRT (p < 0.05). Conclusions: Peripheral lymphopenia after SBRT might be an independent prognostic factor for poorer outcome in HCC patients. Post-treatment lymphocyte subsets, including CD8+ T cell and NK cell counts were also associated with 2-year OS rates.
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Affiliation(s)
- Yuan Zhuang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bao-Ying Yuan
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Gen-Wen Chen
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Mei Zhao
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Hu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Chao Zhu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhao-Chong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Xing Chen
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
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Sun J, Zhang T, Wang J, Li W, Zhang A, He W, Zhang D, Li D, Ding J, Duan X. Biologically effective dose (BED) of stereotactic body radiation therapy (SBRT) was an important factor of therapeutic efficacy in patients with hepatocellular carcinoma (≤5 cm). BMC Cancer 2019; 19:846. [PMID: 31455251 PMCID: PMC6712687 DOI: 10.1186/s12885-019-6063-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/19/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To explore the association between biologically effective dose (BED) and survival rates in Child-Pugh A classification (CP-A) small hepatocellular carcinoma (HCC) patients treated with stereotactic body radiation therapy (SBRT). METHODS This retrospective study included 108 small HCC patients who were treated with SBRT between 2011 and 2014. The prescribed dose delivered to the tumor were 48Gy/8f, 49Gy/7f, 50Gy/5f and 54Gy/6f. The median biologically effective dose (BED10) of the total prescribed dose was 100Gy (76.8-102.6Gy). Factors associated with the survival rate were examined using the Cox proportion hazards model, and the factors associated with radiation-induced liver injury (RILD) were examined by logistic regression analysis. RESULTS For these patients, the median follow-up time was 42 months (6-77 months), and the 1-, 2- and 3-year overall survival (OS) rates were 96.3, 89.8 and 80.6%, respectively. The 1-, 2- and 3-year progression-free survival (PFS) rates were 85.2, 70.1 and 60.6%, respectively. The 1-, 2- and 3-year local control (LC) rates were 98.1, 96.2 and 95.1%, respectively. The 1-, 2- and 3-year distant metastasis- free survival (DMFS) rates were 86.1, 72.8 and 61.2%. The OS, PFS and DMFS were significantly higher in the BED10 ≥ 100Gy group than in the BED10 < 100Gy group (OS: p = 0.020; PFS: p = 0.017; DMFS: p = 0.012). The PLT count was a predictive factor of RILD. CONCLUSIONS SBRT is a safe and effective option for CP-A HCC patients. A BED10 value greater than 100Gy and lower CP score are associated with improved OS and PFS. Additionally, the peripheral PLT count are predictive factors of RILD.
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Affiliation(s)
- Jing Sun
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039 China
| | - Tao Zhang
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039 China
| | - Jia Wang
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039 China
| | - Wengang Li
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039 China
| | - Aimin Zhang
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039 China
| | - Weiping He
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039 China
| | - Dan Zhang
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039 China
| | - Dong Li
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039 China
| | - Junqiang Ding
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039 China
| | - Xuezhang Duan
- Radiation Oncology Center, The Fifth Medical Center of PLA General Hospital (Beijing 302 Hospital), No. 100 Xi Si Huan Middle Road, Fengtai District, Beijing, 100039 China
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