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: 1.27). 01/2010; 96(1):65-70. DOI: 10.1700/479.5653
Source: PubMed


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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    • "With the help of internal markers (fiducials) and synchrony tracking of tumor during respiration. SBRT with Cyberknife (Accuray Inc, Sunnyvale, CA, USA) allows more accurate application by reducing the error margin with reducing the amount of normal tissue exposure during treatment, enhancing the chance of treating larger tumor with limited normal liver available or tumor in close proximity to critical organs [14-17]. Furthermore, fractionated SBRT may have 3 times the biological effect of conventional fractionated radiation therapy [18,19]. "
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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. Methods Between 2009 and 2011, 22 patients with unresectable huge HCC (≧10 cm) were treated with SBRT. dose ranged from 26 Gy to 40 Gy in five fractions. Overall survival (OS) and disease-progression free survival (DPFS) were determined by Kaplan-Meier analysis. Tumor response and toxicities were also assessed. Results After a median follow-up of 11.5 month (range 2–46 months). The objective response rate was achieved in 86.3% (complete response (CR): 22.7% and partial response (PR): 63.6%). The 1-yr. local control rate was 55.56%. The 1-year OS was 50% and median survival was 11 months (range 2–46 months). In univariate analysis, Child-Pugh stage (p = 0.0056) and SBRT dose (p = 0.0017) were significant factors for survival. However, in multivariate analysis, SBRT dose (p = 0.0072) was the most significant factor, while Child-Pugh stage of borderline significance. (p = 0.0514). Acute toxicities were mild and well tolerated. Conclusion This study showed that SBRT can be delivered safely to huge HCC and achieved a substantial tumor regression and survival. The results suggest this technique should be considered a salvage treatment. However, local and regional recurrence remain the major cause of failure. Further studies of combination of SBRT and other treatment modalities may be reasonable.
    Radiation Oncology 05/2014; 9(1):120. DOI:10.1186/1748-717X-9-120 · 2.55 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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    ABSTRACT: Recent technological advances allow precise and safe radiation delivery in hepatocellular carcinoma. Stereotactic body radiotherapy is a conformal external beam radiation technique that uses a small number of relatively large fractions to deliver potent doses of radiation therapy to extracranial sites. It requires stringent breathing motion control and image guidance. Selective internal radiotherapy or radioembolization refers to the injection of radioisotopes, usually delivered to liver tumors via the hepatic artery. Clinical results for both treatments show that excellent local control is possible with acceptable toxicity. Most appropriate patient populations and when which type of radiation therapy should be best employed in the vast therapeutic armamentarium of hepatocellular carcinoma are still to be clarified.
    Cancer/Radiothérapie 02/2011; 15(1):54-63. DOI:10.1016/j.canrad.2010.11.003 · 1.41 Impact Factor
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