Selective internal radiation therapy (SIRT) before partial hepatectomy or radiofrequency destruction for treatment of hepatocellular carcinoma in cirrhotic patients: a feasibility and safety pilot study (original) (raw)
Related papers
Hong Kong Journal of Radiology, 2017
Purpose: To report the outcomes and prognostic factors of overall survival after selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC). Methods: Consecutive patients who underwent SIRT for HCC at Queen Elizabeth Hospital between December 2006 and February 2016 were retrospectively reviewed. Results: 51 male and 11 female patients aged 42 to 90 (median, 66) years were deemed suitable to receive SIRT. Most were hepatitis B carriers and had an Eastern Cooperative Oncology Group performance score of ≤1 and Child-Pugh class A cirrhosis. About half of the patients had portal vein thrombosis and an alpha-fetoprotein level of >200 ng/ml. 30.7% of patients were at Barcelona Clinic Liver Cancer stage B and 64.5% at stage C. 50% of tumours were ≥8 cm at the longest diameter. The median dose received by the tumour was 130 Gy. Three months after SIRT, 1.7% had a complete response, 43.3% had a partial response, 26.7% had stable disease, and 28.3% had progressive disease. The 1-year local control rate was 12.3%. The 1-year overall survival was 30.6%. The median time to tumour progression was 3 months and the median overall survival was 6 months. In multivariate analysis, Child-Pugh class, portal vein thrombosis, and post-SIRT intervention were significant prognostic factors for overall survival. Conclusion: SIRT is an effective and safe treatment for intermediate-to advanced-stage HCC. It achieves good local control with minimal toxicity although the outcome is unsatisfactory in terms of new intrahepatic or distant recurrence. HCC patients with Child-Pugh class A cirrhosis, no portal vein thrombosis, and an ability to undergo subsequent treatments have longer survival.
Cureus, 2020
Purpose: We aim to provide results of the real-world experience of a single center in Lebanon on the use of radioembolization to treat liver-only or liver-dominant tumors. Methods: This retrospective review included patients who were evaluated for radioembolization between January 2015 and June 2017 and who had a lung shunt fraction of 20% or less. Tumor responses were determined using the response evaluation criteria in solid tumors (RECIST). Results: Of the 23 Arab patients with a median age of 64 years (range, 36-87 years), eight had hepatocellular carcinoma, four had cholangiocarcinoma, and 11 had liver-only or liverdominant metastases from other primary cancers. Most (n=17) had multifocal lesions, and 13 had a history of branched (n=8) or main (n=5) portal vein thrombosis. When appropriate, the gastroduodenal artery and middle hepatic artery were embolized for consolidation of radiotherapy; 18 patients required arterial coil occlusion, two had their cystic artery occluded, and one developed cholecystitis, which was successfully treated with antibiotics and supportive care. Another patient developed a post-radioembolization complication-a peptic ulcer unrelated to arterial reflux of microspheres because both the gastroduodenal and right gastric arteries were occluded. The median time to progression was seven months (range, 3-36 months), and median overall survival from radioembolization was 12 months (range, 3-40 months). Tumor responses included five complete responses, 13 partial responses, one stable disease, and four cases of progressive disease. Conclusion: Performing radioembolization in a non-referral, private center in Lebanon resulted in good patient outcomes with few complications.
Research Square (Research Square), 2019
Background Numerous studies have demonstrated that radioembolization of the liver with yttrium-90 microspheres provides a survival advantage for patients with unresectable primary or secondary tumors of the liver. The goal of this study was to provide results of the real-world experience of a single center in Lebanon with the use of radioembolization to treat liver-only or liver-dominant tumors. Methods Patients were included in this retrospective review if they were evaluated for radioembolization between January 2015 and June 2017 and had a lung shunt fraction of 20% or less. Tumor responses were determined using the Response Evaluation Criteria In Solid Tumors. Results Of the 23 patients treated with radioembolization, 8 had hepatocellular carcinoma, 4 had cholangiocellular carcinoma, and 11 had liveronly or liver-dominant metastases from other primary cancers. All were Middle Eastern, with a median age of 64 years (range 36-87 years), and 14 were men. A majority (n=19) had an initial tumor volume of 49% or less. Most (n=17) had multifocal lesions, and 8 had a history of branched or main portal vein thrombosis. Eighteen patients required arterial coil occlusion. Two patients had their cystic artery occluded, and one of these patients developed cholecystitis, which was successfully treated with
Selective internal radiation therapy: An emerging treatment for hepatorectal cancer
The paper has reviewed the use of Selective Internal Radiation Therapy (SIRT) using SIR-Spheres, which is a therapeutic 'device' for the treat-ment of non-resectable hepatic metastases secondary to colorectal can-cer in the absence of extrahepatic metastases. SIRT involves a single de-livery of Yttrium 90 micro-spheres in the hepatic artery. Preferential uptake is achieved into liver tumors, because of their predominant hepatic arterial blood supply. The treatment is well tolerated and has been documented internationally to achieve response rates of around 90% in patients with extensive colorectal cancer (CRC) liver metastases. The product obtained FDA approval in the USA in 2002. Unlike other ablative therapies being applied to non-resectable liver tumors, SIRT is indicated even in patients with an extensive burden of liver tumor. Indications, dosing schedules and expected outcomes will be better defined. 2013 Trade Science Inc. -INDIA INTRODUCTION [1-12]
Liver Cancer, 2016
A consensus meeting to develop practice guidelines and to recommend future clinical trials for radiation therapy (RT), including external beam RT (EBRT), and selective internal RT (SIRT) in hepatocellular carcinoma (HCC) was held at the 5th annual meeting of the Asia-Pacific Primary Liver Cancer Expert consortium. Although there is no randomized phase III trial evidence, the efficacy and safety of RT in HCC has been shown by prospective and retrospective studies using modern RT techniques. Based on these results, the committee came to a consensus on the utility and efficacy of RT in the management of HCC according to each disease stage as follows: in early and intermediate stage HCC, if standard treatment is not compatible, RT, including EBRT and SIRT can be considered. In locally advanced stage HCC, combined EBRT with transarterial chemoembolization or hepatic arterial infusion chemotherapy, and SIRT can be considered. In terminal stage HCC, EBRT can be considered for palliation of symptoms and reduction of morbidity caused by the primary tumor or its metastases. Despite the currently reported benefits of RT in HCC, the committee agreed that there is a compelling need for large prospective studies, including randomized phase III trial evidence evaluating the role of RT. Specifically studies evaluating the efficacy and safety of sequential combination of EBRT and SIRT are strongly recommended.
Radiotherapy and hepatocellular carcinoma: update and review of the literature
European review for medical and pharmacological sciences, 2012
Historically radiotherapy has always played a limited role for the treatment of HCC due to the low tolerance of the liver and the subsequent risk of radiation induced liver disease (RILD). Technologist advancements in radiation planning and treatment delivery such as Stereotactic Body Radiotherapy (SBRT) combined with Image Guided Radiotherapy (IGRT) has allowed us to further increase tumor dose while maximally sparing the surrounding not involved liver. Furthermore, together with the growing knowledge of radiobiological models in liver disease, several mono-institutional retrospective and prospective series are reporting very encouraging results. Therefore, radiotherapy might play a significant role for the treatment of unresectable HCC, alone or combined with other locoregional treatment such as transarterial chemoembolisation (TACE). The rationale for studying this technique is really strong and it should be tested in well designed prospective randomized clinical trials.
Curative Irradiation Treatment of Hepatocellular Carcinoma: A Multicenter Phase 2 Trial
International Journal of Radiation Oncology*Biology*Physics, 2020
Purpose/Objective Liver transplantation is the standard definitive treatment for non-metastatic hepatocellular carcinoma (HCC). However, less than 5% of patients are ultimately candidates due to frequent comorbidities and graft shortage. The aim of this study was to evaluate stereotactic body radiotherapy (SBRT) as an ablative treatment for inoperable HCC. Material/methods A prospective phase II trial included newly-diagnosed single HCC lesion; without extrahepatic extension; deemed unsuitable for standard loco-regional therapies; with a tumor size from 1 to 6 cm. The SBRT dose was 45 Gy in 3 fractions. Primary endpoint was the local control of irradiated HCC at 18 months, defined by RECIST (Response Evaluation Criteria in Solid Tumors). Results Forty three patients were treated and evaluable. Median follow-up was 4.0 years (range, 1.2 to 4.6 years). All 43 patients had cirrhosis, 37 (88%) were Child-Pugh (CP) grade A, and 5 (12%) grade B (1 missing data). No patients had received prior local treatment. Thirteen patients (31%) presented grade ≥ 3 acute adverse events, including 8 patients with an abnormality of the liver function tests (19%). Three patients (10%) experienced a decline in CP at 3 months post-SBRT. The 18-month local control rate was 98% (95% confidence interval, 85%-99%). The 18-month overall survival (OS) rate was 72% (56%-83%). Median OS was 3.5 years. Conclusion Local control and overall survival after SBRT for untreated solitary HCC were excellent despite candidates being unfit for transplantation, resection, ablation or embolization treatments. SBRT should be considered, as bridging to transplant or as definitive therapy for those ineligible for transplant.
Selective internal radiation therapy (SIRT) in primary or secondary liver cancer
Methods, 2011
Most patients with a history of common solid tumors will in the end develop liver metastases. Next to that, primary liver cancer, is a frequent cancer with fatal liver failure in the majority of patients. Selective internal radiation therapy (SIRT), has gradually been introduced over the recent years and is a promising, innovative albeit palliative treatment modality. The specific clinical background with regard to the indication and methodology of SIRT is presented and discussed in this paper.
Nonsurgical options for hepatocellular carcinoma: Evolving role of external beam radiotherapy
Cancer control: journal of the Moffitt Cancer Center
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and thus poses a global concern. Its incidence is expected to increase in North America secondary to the increasing incidence of patients who develop hepatitis C. Patients who ultimately develop cirrhosis have an increased risk of developing hepatocellular carcinoma. The authors focus on nonsurgical therapies for this disease with an exploration of how external beam radiotherapy can be used alone or with other modalities. The development of partial liver strategies secondary to an explosion in radiation treatment planning and delivery advances is reviewed. Integration of advanced technology has evolved from three-dimensional conformal treatment to intensity-modulated radiation therapy and image-guided radiation therapy, along with stereotactic body radiation therapy, tomotherapy, and proton beam therapy. Current data show a promising future for treatment strategies incorporating radiation with high rates of inf...