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Pilot study of stereotactic body radiotherapy for huge hepatocellular carcinoma unsuitable for other therapies.

Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
Tumori (Impact Factor: 1.09). 01/2010; 96(1):65-70.
Source: PubMed

ABSTRACT To determine the feasibility and efficacy of stereotactic body radiotherapy (SBRT) for huge hepatocellular carcinoma unsuitable for other therapies.
Six patients with very large hepatocellular carcinomas (>10 cm) unsuitable for surgical resection or that failed to respond to transcatheter arterial chemoembolization (TACE) were treated by SBRT. Doses ranged from 32 Gy to 40 Gy in four fractions. Survival, response, and toxicities were evaluated.
After a median follow-up of 25.9 months (range 8.1-56 months), three patients had died and three were alive. Overall, treatment was well tolerated and no dose-limiting toxicity or radiation-induced liver disease was observed. The median survival was 10 months (range 3-56 months) and the median progression-free duration was 6 months (range, 2-21 months). Partial response was achieved by four patients, stable disease by one, and one patient had disease progression. One patient with a partial response who underwent lobectomy after SBRT was alive 56 months post-SBRT.
This study suggests that SBRT can be delivered safely at 32-40 Gy in four fractions to huge hepatocellular carcinoma. Furthermore, combinations of SBRT with other modalities such as surgery or TACE might prolong survival.

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    ABSTRACT: Background and aim: To evaluate the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients with unresectable huge hepatocellular carcinoma (HCC) unsuitable of other standard treatment option.
    Radiation Oncology 05/2014; 9(1):120. DOI:10.1186/1748-717X-9-120 · 2.36 Impact Factor
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    ABSTRACT: Background Hepatic tumors can be either primary disease (i.e., hepatocellular carcinoma) or a site of metastases from other solid malignancies. The primary therapy for all liver tumors is resection, but only a minority of patients present with resectable disease. Various nonsurgical ablative techniques have been investigated to cure or palliate unresectable hepatic tumors by improving locoregional control. Purpose The objective of this article is to review the radiotherapy options in managing primary or metastatic liver cancer. Design and methods Two emerging radical radiotherapy options include stereotactic body radiation therapy (SBRT) and selective internal radiotherapy (SIRT). SBRT delivers ablative doses of radiation in a hypofractionated course and has been used in metastatic disease to the brain, spine, lung, and liver. The local tumor control for SBRT appears to exceed that of conventional fractionation external beam radiotherapy (EBRT). SIRT, also known as radioembolization, is the intraarterial delivery of microspheres impregnated with yttrium-90 (Y90) via the hepatic artery. The evidence is limited to cohort and comparative studies with historical controls; nonetheless, results appear to be promising. Both SBRT and SIRT to liver tumors may serve as a bridge to liver transplantation (LT) and as a treatment strategy for metastasis from colorectal cancer to achieve the effect of metastasectomy. Meanwhile, combining molecular-targeted agents with radiotherapy is an emerging strategy to enhance the therapeutic ratio. Conclusion SBRT and/or SIRT are promising local ablative modalities for management of unresectable liver tumors. Further well-designed trials are warranted to establish the proper combination of different therapeutic modalities.
    09/2012; 1(3). DOI:10.1007/s13566-012-0045-8

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