Stereotactic body radiotherapy in pancreatic adenocarcinoma

Background:Stereotactic body radiotherapy(SBRT)in pancreatic cancer allows high delivery of radiation doses on tumors without affecting surrounding tissue.This review aimed at the SBRT application in the treatment of pancreatic cancer.Data sources:We retrieved articles published in MEDLINE/PubMed from January 2017 to December 2022.Keywords used in the search included:“pancreatic adenocarcinoma”OR“pancreatic cancer”AND“stereotactic ablative radiotherapy(SABR)”OR“stereotactic body radiotherapy(SBRT)”OR“chemoradiotherapy(CRT)”.English language articles with information on technical characteristics,doses and fractionation,indications,recurrence patterns,local control and toxicities of SBRT in pancreatic tumors were included.All articles were assessed for validity and relevant content.Results:Optimal doses and fractionation have not yet been defined.However,SBRT could be the standard treatment in patients with pancreatic adenocarcinoma in addition to CRT.Furthermore,the combination of SBRT with chemotherapy may have additive or synergic effect on pancreatic adenocarcinoma.Conclusions:SBRT is an effective modality for patients with pancreatic cancer,supported by clinical practice guidelines as it has demonstrated good tolerance and good disease control.SBRT opens a possibility of improving outcomes for these patients,both in neoadjuvant treatment and with radical intent.

Stereotactic body radiotherapy combined with sintilimab in patients with recurrent or oligometastatic hepatocellular carcinoma: A phase Ⅱ clinical trial

BACKGROUND Stereotactic body radiotherapy(SBRT)and programmed cell death 1 inhibitors have shown potential in treating hepatocellular carcinoma(HCC)in retrospective studies.AIM To evaluate the efficacy of combining SBRT with sintilimab for patients with recurrent or oligometastatic HCC.METHODS This trial involved patients with recurrent or oligometastatic HCC intravenously treated with SBRT plus sintilimab every 3 wk for 12 mo or until disease progression.The primary endpoint was progression-free survival(PFS).RESULTS Twenty-five patients were enrolled from August 14,2019,to August 23,2021.The median treatment duration was 10.2(range,0.7-14.6)months.SBRT was delivered at a median dose of 54(range,48-60)Gy in 6(range,6-10)fractions.The median follow-up time was 21.9(range,10.3-39.7)mo,and 32 targeted lesions among 25 patients were evaluated for treatment response according to the Response Evaluation Criteria in Solid Tumors version 1.1.The median PFS was 19.7 mo[95%confidence interval(CI):16.9-NA],with PFS rates of 68%(95%CI:52-89)and 45.3%(95%CI:28-73.4)at 12 and 24 mo,respectively.The median overall survival(OS)was not reached,with OS rates of 91.5%(95%CI:80.8-100.0)and 83.2%(95%CI:66.5-100.0)at 12 and 24 mo,respectively.The 1-and 2-year local control rate were 100%and 90.9%(95%CI:75.4%-100.0%),respectively.The confirmed objective response rate and disease control rate was 96%,and 96%,respectively.Most adverse events were graded as 1 or 2,and grade 3 adverse events were observed in three patients.CONCLUSION SBRT plus sintilimab is an effective,well-tolerated treatment regimen for patients with recurrent or oligometastatic HCC.

Initial experience with stereotactic body radiotherapy for intrahepatic hepatocellular carcinoma recurrence after liver transplantation

BACKGROUND Graft hepatocellular carcinoma(HCC)recurrence after liver transplant is more frequently encountered.Graft hepatectomy is technically challenging and is associated with high morbidity.Stereotactic body radiation therapy(SBRT)has been shown to be safe and effective for the treatment of primary HCC.However,its role in HCC recurrence in a liver graft remains unclear.AIM To evaluate the safety and efficacy of SBRT for the treatment of graft HCC recurrence after liver transplantation.METHODS A retrospective study was conducted.From 2012 to 2018,6 patients with intrahepatic HCC recurrence after liver transplant were treated with SBRT at Queen Mary Hospital,the University of Hong Kong.The primary outcome was time to overall disease progression and secondary outcomes were time to local progression and best local response,as assessed with the Modified response Evaluation Criteria for Solid Tumours criteria.Patients were monitored for treatment related toxicities and graft dysfunction.RESULTS A total of 9 treatment courses were given for 13 tumours.The median tumour size was 2.3 cm(range 0.7-3.6 cm).Two(22%)patients had inferior vena cava tumour thrombus.The best local treatment response was:5(55%)complete response,1(11%)partial response and 3(33%)stable disease.After a median follow up duration of 15.5 mo,no local progression or mortality was yet observed.The median time to overall disease progression was 6.5 mo.There were 6 regional progression in the liver graft(67%)and 2 distant progression in the lung(22%).There was no grade 3 or above toxicity and there was no graft dysfunction after SBRT.CONCLUSION SBRT appears to be safe in this context.Regional progression is the mode of failure.

Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy

AIM To evaluate the control, survival, and hepatic function for Child Pugh(CP)-A patients after Stereotactic body radiotherapy(SBRT) in hepatocellular carcinoma(HCC).METHODS From 2009 to 2016, 40 patients with Barcelona Liver Clinic(BCLC) stages 0-B HCC and CP-A cirrhosis completed liver SBRT. The mean prescription dose was 45 Gy(40 to 50 Gy in 4-5 fractions). Local relapse, defined as recurrence within the planning target volume was assessed with intravenous multiphase contrast computed tomography or magnetic resonance imaging every 4-6 mo after completion of SBRT. Progression of cirrhosis was evaluated by CP and Model for End Stage Liver Disease scores every 3-4 mo. Toxicities were graded per the Common Terminology Criteria for Adverse Events(v4.03). Median follow-up was 24 mo.RESULTS Forty-nine HCC lesions among 40 patients were analyzed in this IRB approved retrospective study. Median tumor diameter was 3.5 cm(1.5-8.9 cm). Six patients with tumors ≥ 5 cm completed planned selected transarterial chemoembolization(TACE) in combination with SBRT. Eight patients underwent orthotropic live transplant(OLT) with SBRT as a bridging treatment(median time to transplant was 12 mo, range 5 to 23 mo). The Pathologic complete response(PCR) rate in this group was 62.5%. The 2-year in-field local control was 98%(1 failure). Intrahepatic control was 82% and 62% at 1 and 2 years, respectively. Overall survival(OS) was 92% and 60% at 1 and 2 years, with a median survival of 41 mo per Kaplan Meier analysis. At 1 and 2 years, 71% and 61% of patients retained CPA status. Of the patients with intrahepatic failures, 58% developed progressive cirrhosis, compared to 27% with controlled disease(P = 0.06). Survival specific to hepatic failure was 92%, 81%, and 69% at 12, 18, and 24 mo. There was no grade 3 or higher toxicity. On univariate analysis, gross tumor volume(GTV) < 23 cc was associated with freedom from CP progression(P = 0.05), hepatic failure-specific survival(P = 0.02), and trended with OS(P = 0.10).CONCLUSION SBRT is safe and effective in HCC with early cirrhosis and may extend waiting time for transplant in patients who may not otherwise be immediate candidates.

The effects of stereotactic body radiotherapy on peripheral natural killer and CD3~+CD56~+ NKT-like cells in patients with hepatocellular carcinoma

Background: Both natural killer(NK) and CD3+CD56+ natural killer T(NKT)-like cells play critical roles in the antitumor response. This study aimed to explore the effects of stereotactic body radiotherapy(SBRT) on peripheral NK and NKT-like cells in patients with hepatocellular carcinoma(HCC), and to identify possible surface markers on these cells that correlate with the prognosis. Methods: Twenty-five HCC patients were prospectively enrolled in our study, and 10 healthy individuals were served as healthy controls. Flow cytometry was used to determine the counts and the percentages of peripheral NK and NKT-like cells, cells with certain receptors, and cells with intracellular interferon-γand TNF-α secretion at different time points, including time points of prior to SBRT, at post-SBRT, and 3-month and 6-month after treatment. The Kaplan-Meier method with the log-rank test was applied for survival analysis. Results: The peripheral NKT-like cells was increased at post-SBRT. Meanwhile, elevated levels of inhibitory receptors and reduced levels of activating receptors of NK cells were also observed in NK cells at post-SBRT, but the levels was not significantly different at 3-month and 6-month as compared with the baseline levels. Lower percentage of NKp30+ NK cells before SBRT and higher percentage of CD158b + NK cells after SBRT were associated with poor progression-free survival. In addition, higher percentage of CD3+CD56+ NKT-like cells was associated with a higher overall survival rate in HCC patients. Conclusions: SBRT has an apparent effect on both peripheral NK and CD3+ CD56+ NKT-like cells. Lower percentage of NKp30 + NK cells before SBRT and higher percentage of CD158b + NK cells after SBRT are correlated with poor patients' PFS. Higher percentage of CD3+ CD56+ NKT-like cells is associated with higher OS in HCC patients.

Hepatocellular carcinoma effective stereotactic body radiotherapy using Gold Anchor and the Synchrony system:Two case reports and review of literature

BACKGROUND Radiotherapy for hepatocellular carcinoma(HCC)is considered to have limited efficacy because of treatment intensity considering that the irradiated area includes the liver,which is highly radiosensitive.In this report,we present two cases in which tumor control by surgical resection,radiofrequency ablation,transcatheter arterial chemoembolization(TACE),and lenvatinib administration was difficult,but stereotactic body radiotherapy(SBRT)using the Synchrony system by Radixact?and Gold Anchor?(GA)was effective.CASE SUMMARY A 60-year-old man had a single 10-cm HCC in the right lobe.Viable lesions remained after TACE,and levels of alpha-fetoprotein and protein induced by vitamin K antagonists II(PIVKA-II)decreased and quickly re-elevated.We performed SBRT with GA.Three weeks after implantation,localized radiotherapy(SBRT;40 Gy/5 fractions)was performed using the Synchrony system by Radixact?.Four weeks later,the viable lesion had disappeared,and the PIVKA-II levels decreased.A 77-year-old man had a single 12-cm HCC in the right lobe.The patient experienced recurrence after hepatectomy.Further recurrence occurred after TACE,and we performed SBRT with GA.Because of the proximity of the HCC to the gastrointestinal tract,localized radiotherapy(SBRT;39 Gy/13 fractions)to the HCC was performed 3 wk after implantation using the Synchrony system by Radixact?.Four weeks later,the viable lesion had disappeared on computed tomography,and the PIVKA-Ⅱlevels decreased.CONCLUSION SBRT using the Synchrony system and GA can deliver a large dose accurately and safely,and could have a high therapeutic effect.

Delivered Dose Verification for Lung Cancer Stereotactic Body Radiotherapy Using Cone-Beam CT

Purpose: Verified the delivered dose distribution of lung cancer Stereotactic Body Radiotherapy (SBRT) using the cone-beam CT images. Methods: Twenty lung cancer patients who underwent SBRT with 100 CBCT images were enrolled in this study. Delivered dose distributions were recalculated on CBCT images with the deformed and non-deformed methods, respectively. The planned and delivered dose distributions were compared using the dose-volume histograms. Results: The delivered target coverage (V100) per patient inside target volume deviated on average were 0.83% ± 0.86% and 1.38% ± 1.40% for Pct vs. Pcbct and Pct vs. Pdcbct, respectively. The Conformity Index (CI) and Gradient Index (GI) showed a good agreement among the plans. For the critical organs, only minor differences were observed between the planned dose and the delivered dose. Conclusions: CBCT images were a useful tool for setup and dose delivery verification for lung cancer patients who underwent SBRT.

Observation on the Clinical Effect of Stereotactic Body Radiotherapy in Patients with Oligometastatic Tumors

Objective:To observe the efficacy and safety of stereotactic body radiotherapy(SBRT)in the treatment of extracranial oligometastases.Method:A retrospective analysis of 70 patients with extracranial oligometastasis of malignant tumors who underwent SBRT in our hospital(Shaanxi Provincial People’s Hospital)from January 2019 to December 2021 with≤5 metastases,≤3 metastatic organs,and metastases with diameters of≤5 cm.According to the clinical data of patients,the dose-fractionation mode of SBRT is mainly determined according to the pathology of the primary tumor,the location of the metastatic tumor,and the important structures around the tumor.The local control,survival and adverse reactions were observed.Results:A total of 219 oligometastatic lesions in 70 patients were treated with SBRT.The median follow-up time was 24 months(12-40 months).The local control rate(LCR)of all target lesions assessed 3 months after radiotherapy was 94.1%;the 1-,2-,and 3-year LCRs were 88.6%,74.6%,and 64.9%,respectively.The median progression-free survival(PFS)was 11.8 months(95%CI,8.9-14.7 months),and the 1-and 2-year PFS rates were 48.6%and 32.6%,respectively;the median overall survival(OS)was 31.9 month(95%CI 26.0-37.8 months),the 1-year OS rate was 84.3%.The local control time,PFS,and OS of patients with metastases≤3 cm were significantly better than those with metastases>3 cm,and the differences were statistically significant(P<0.05).Acute adverse reactions after SBRT treatment in oligometastatic patients were mainly bone marrow suppression and gastrointestinal reactions,with incidence rates of 48.98%and 30.61%,respectively;chronic adverse reactions were mainly pain(bone,muscle),radiation enteritis,and radiation pneumonitis,with incidence rates of 38.57%,30.00%,and 24.29%,respectively.The treatment-related adverse reactions were mainly grade 1,which were all improved after symptomatic treatment,except for one patient with bone metastases from lung cancer who had grade 4 myelosuppression.No grade 4 or 5 adverse events occurred in the other patients.Conclusion:The application of SBRT in the treatment of extracranial oligometastases is safe,effective,and has high tolerability.

Percutaneous local tumor ablation vs. stereotactic body radiotherapy for early-stage non-small cell lung cancer: a systematic review and meta-analysis

Background:Percutaneous local tumor ablation(LTA)and stereotactic body radiotherapy(SBRT)have been regarded as viable treatments for early-stage lung cancer patients.The purpose of this study was to compare the efficacy and safety of LTA with SBRT for early-stage non-small cell lung cancer(NSCLC).Methods:PubMed,Embase,Cochrane library,Ovid,Google scholar,CNKI,and CBMdisc were searched to identify potential eligible studies comparing the efficacy and safety of LTA with SBRT for early-stage NSCLC published between January 1,1991,and May 31,2021.Hazard ratios(HRs)or odds ratios(ORs)with 95%confidence intervals(CIs)were applied to estimate the effect size for overall survival(OS),progression-free survival(PFS),locoregional progression(LP),and adverse events.Results:Five studies with 22,231 patients were enrolled,including 1443 patients in the LTA group and 20,788 patients in the SBRT group.The results showed that SBRT was not superior to LTA for OS(HR=1.03,95%CI:0.87-1.22,P=0.71).Similar results were observed for PFS(HR=1.09,95%CI:0.71-1.67,P=0.71)and LP(HR=0.66,95%CI:0.25-1.77,P=0.70).Subgroup analysis showed that the pooled HR for OS favored SBRT in patients with tumors sized>2 cm(HR=1.32,95%CI:1.14-1.53,P=0.0003),whereas there was no significant difference in patients with tumors sized≤2 cm(HR=0.93,95%CI:0.64-1.35,P=0.70).Moreover,no significant differences were observed for the incidence of severe adverse events(≥grade 3)(OR=1.95,95%CI:0.63-6.07,P=0.25)between the LTA group and SBRT group.Conclusions:Compared with SBRT,LTA appears to have similar OS,PFS,and LP.However,for tumors>2 cm,SBRT is superior to LTA in OS.Prospective randomized controlled trials are required to determine such findings.

Stereotactic radiotherapy for intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma(iCCA)is an aggressive malignancy with an increasing incidence worldwide and poor prognosis,despite several advances and continuous efforts to develop effective treatments.Complete surgical resection is the mainstay of treatment and offers a potentially curative option,but is only possible in less than a third of patients,owing to advanced disease.Chemotherapy is a well-established treatment in the adjuvant and palliative setting,however,confers limited benefit.Conventional radiotherapy is challenging due to local toxicity.With recent advances in stereotactic ablative radiotherapy(SABR),it is now possible to focus ablative beams of radiotherapy precisely aimed at tumours to minimise damage to surrounding viscera.This review details the history,technical background and application of SABR to iCCA,with directions for future research suggested.

Single-fraction stereotactic ablative body radiation therapy for primary and metastasic lung tumor:A new paradigm?

Stereotactic ablative body radiotherapy(SABR)is an effective technique comparable to surgery in terms of local control and efficacy in early stages of non-small cell lung cancer(NSCLC)and pulmonary metastasis.Several fractionation schemes have proven to be safe and effective,including the single fraction(SF)scheme.SF is an option costeffectiveness,more convenience and comfortable for the patient and flexible in terms of its management combined with systemic treatments.The outbreak of the severe acute respiratory syndrome coronavirus 2 pandemic has driven this not new but underutilized paradigm,recommending this option to minimize patients’visits to hospital.SF SABR already has a long experience,strong evidence and sufficient maturity to reliably evaluate outcomes in peripheral primary NSCLC and there are promising outcomes in pulmonary metastases,making it a valid treatment option;although its use in central locations,synchronous and recurrencies tumors requires more prospective safety and efficacy studies.The SABR radiobiology study,together with the combination with systemic therapies,(targeted therapies and immunotherapy)is a direction of research in both advanced disease and early stages whose future includes SF.

Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy

BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option.

Indications of external radiotherapy for hepatocellular carcinoma from updated clinical guidelines: Diverse global viewpoints

significantly vary among regions.Modern standard treatments commonly require multidisciplinary approaches,including applications of up-to date medicine and advanced procedures,and necessitate the support of socioeconomic systems.For these reasons,a number of clinical guidelines for HCC from different associations and regions have been presented.External beam radiation therapy was contraindicated for HCC until a few decades ago,but with the development of new technologies,its application has rapidly increased as selective irradiation for tumorous lesions became possible.Most of the guidelines had been opposed or indifferent to radiotherapy in the past,but several guidelines have introduced indications and recommendations for radiotherapy in their updated versions.This review will discuss the characteristics of important guidelines and their contents regarding radiotherapy and will also provide guidance to physicians who are considering applications of locoregional modalities that include radiotherapy.

Role of modern radiotherapy in managing patients with hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is the most common type of primary liver cancer.Several treatment options are available for managing HCC patients,classified roughly as local,local-regional,and systemic therapies.The high postmonotherapy recurrence rate of HCC urges the need for the use of combined modalities to increase tumor control and patient survival.Different international guidelines offer treatment recommendations based on different points of view and classification systems.Radiotherapy(RT)is a well-known local-regional treatment modality for managing many types of cancers,including HCC.However,only some of these treatment guidelines include RT,and the role of combined modalities is rarely mentioned.Hence,the present study reviewed clinical evidence for the use of different combined modalities in managing HCC,focusing on modern RT's role.Modern RT has an increased utility in managing HCC patients,mainly due to two driving forces.First,technological advancement(e.g.,stereotactic body radiotherapy and advanced proton-beam therapy)enables precise delivery of radiation to increase tumor control and reduce side effects in the surrounding normal tissue.Second,the boom in developing target therapies and checkpoint-blockade immunotherapy prolongs overall survival in HCC patients,re-emphasizing the importance of local tumor control.Remarkably,RT combines with systemic therapies to generate the systemic therapy augmented by radiotherapy effect,a benefit now being actively investigated.

Hepatocellular carcinoma Liver Imaging Reporting and Data Systems treatment response assessment: Lessons learned and future directions

Hepatocellular carcinoma(HCC)is a leading cause of morbidity and mortality worldwide,with rising clinical and economic burden as incidence increases.There are a multitude of evolving treatment options,including locoregional therapies which can be used alone,in combination with each other,or in combination with systemic therapy.These treatment options have shown to be effective in achieving remission,controlling tumor progression,improving disease free and overall survival in patients who cannot undergo resection and providing a bridge to transplant by debulking tumor burden to downstage patients.Following locoregional therapy(LRT),it is crucial to provide treatment response assessment to guide management and liver transplant candidacy.Therefore,Liver Imaging Reporting and Data Systems(LI-RADS)Treatment Response Algorithm(TRA)was created to provide a standardized assessment of HCC following LRT.LIRADS TRA provides a step by step approach to evaluate each lesion independently for accurate tumor assessment.In this review,we provide an overview of different locoregional therapies for HCC,describe the expected post treatment imaging appearance following treatment,and review the LI-RADS TRA with guidance for its application in clinical practice.Unique to other publications,we will also review emerging literature supporting the use of LI-RADS for assessment of HCC treatment response after LRT.

High Dose-Volume SBRT Following TACE Improves Clinical Outcomes of Patients with Unresectable Hepatocellular Carcinoma

This study aimed to investigate the dose-volume effects of γ-ray stereotactic body radiotherapy (SBRT) on clinical outcomes of patients with huge-size (≥10 cm) unresectable hepatocellular carcinoma (HCC). A total of 59 patients with huge-size unresectable HCC were treated with SBRT following TACE between May 2006 and Dec. 2009. The analyzed parameters included fractional dose, marginal dose, maximal dose, and mean dose that the target received, as well as percentages of tumor volume encompassed by 60% (P60), 70% (P70), and 80% (P80) of isodose curves in entire tumor. The clinical outcomes included objective response rate (ORR), disease-free survival (DFS), overall survival (OS), and adverse event (AE). During median follow-up of 18.4 months, 81.4% of ORR (8.5% CR and 72.9% PR) was achieved, higher than 28.9% of ORR recently reported for TACE alone. 1- and 3-year DFS rates were 31.1% and 2.6% with median DFS of 8.7 months;1-, 3-, and 5-year OS rates were 46.5%, 13.7%, and 2.9%, with median OS of 11.8 months. P70 was the only factor significantly correlating to DFS (P = 0.009) and OS (P = 0.01). Neither severe radiation-related liver disease nor > grade 3 AE was observed. In conclusion, SBRT was a safe and effective option for treatment of huge-size unresectable HCC. P70 represented a parameter for predicting DFS and OS, and high dose-volume (e.g., P70) might be required to achieve improved clinical outcomes of patients with this type of HCC.

New perspectives in the management of small cell lung cancer

The treatment of small cell lung cancer(SCLC)is a challenge for all specialists involved.New treatments have been added to the therapeutic armamentarium in recent months,but efforts must continue to improve both survival and quality of life.Advances in surgery and radiotherapy have resulted in prolonged survival times and fewer complications,while more careful patient selection has led to increased staging accuracy.Developments in the field of systemic therapy have resulted in changes to clinical guidelines and the management of patients with advanced disease,mainly with the introduction of immunotherapy.In this article,we describe recent improvements in the management of patients with SCLC,review current treatments,and discuss future lines of research.

Role of Radiotherapy in the Treatment of Hepatocellular Carcinoma

The role of radiotherapy in the treatment of hepatocellular carcinoma(HCC)has evolved over the past few decades with the advancement of technology and improved imaging.Radiotherapy can offer high local control rates in unresectable HCC,including cases with major vascular involvement,and can provide a modality to help bridge patients to potentially curative resection or transplantation.In metastatic cases,radiotherapy can provide good palliation.This review focuses on the common radiotherapy treatment modalities used for HCC,provides outcome comparisons of these radiotherapy techniques to outcomes with other treatment modalities for HCC,and highlights the discrepancy of the role of radiotherapy in HCC amongst the current available treatment guidelines.

Can radiotherapy finally “go live” in the management of liver metastases?

Liver metastases can present synchronously or at different time points.While systemic therapy continues to be the mainstay of treatment for patients with liver metastases,it is unlikely to completely eradicate the disease.Surgical“metastectomy”for patients with limited metastatic burden,particularly from colorectal cancers,has been shown to improve survival.However,owing to medical co-morbidities or tumour location,not all patients are eligible for surgical resection.In recent years,there has been an increase in the use of non-surgical techniques,including high dose radiation using stereotactic body radiotherapy,or brachytherapy,to ablate liver metastases.The purpose of this narrative review is to describe the role of radiotherapy in the management of liver metastases,both for local ablation and symptom palliation.We will elaborate on the techniques used,patient selection process,expected outcomes and toxicities based on the current literature.

New Staging Model for Radiation-based Hepatocellular Carcinoma Treatment:A National Multicenter Study

Background and Aims:The study aimed to create a new staging model for radiotherapy-based treatment for prognostic hepatocellular carcinoma(HCC)classification.Methods:The training cohort comprised 658 patients receiving stereotactic body radiotherapy and external validation cohort comprised 533 patients receiving three-dimensional conformal radiotherapy and intensity-modulated radiotherapy.We established a modified staging system as follows:stage I,solitary nodule without macrovascular invasion,or 2–3 nodules no more than 3.0 cm apart,and performance status(PS)0–2(Ia:ALBI-1 grade;Ib:ALBI-2 or 3 grade);stage II:2–3 nodules with any one nodule more than 3.0-cm apart,or≥4 nodules,and performance status 0–2(IIa:ALBI-1 grade;IIb:ALBI-2 grade);stage III:macrovascular invasion,regional lymph node metastasis or distant metastasis,and performance status 0–2(IIIa:ALBI-1 grade;IIIb:ALBI-2 grade);stage IV:performance status 3–4,or performance status 0–2 with ALBI-3 grade.We analyzed longterm overall survival based on different stages.Results:The staging model showed an excellent ability to discriminate patients according to four stages and seven substages with notably different curves in the training and validation cohort.The median survival decreased from stages I to IV with 63.0 months in stage I(not reached in Ia,and 53.0 months in Ib),24.0 months in stage II(28.0 months in IIa,and 22.0 months in IIb),11.0 months in stage III(18.0 months in IIIa,and 9.0 months in IIIb),and less than 9.0 months in stage IV in the training cohort.Conclusions:The modified staging model may provide an alternative for clinical radiation oncologists.