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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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Baishideng Publishing Group Inc
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5752960/ https://www.ncbi.nlm.nih.gov/pubmed/29359031 http://dx.doi.org/10.4240/wjgs.v9.i12.256 |
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author | Hasan, Shaakir Thai, Ngoc Uemura, Tadahiro Kudithipudi, Vijay Renz, Paul Abel, Stephen Kirichenko, Alexander V |
author_facet | Hasan, Shaakir Thai, Ngoc Uemura, Tadahiro Kudithipudi, Vijay Renz, Paul Abel, Stephen Kirichenko, Alexander V |
author_sort | Hasan, Shaakir |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5752960 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-57529602018-01-22 Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy Hasan, Shaakir Thai, Ngoc Uemura, Tadahiro Kudithipudi, Vijay Renz, Paul Abel, Stephen Kirichenko, Alexander V World J Gastrointest Surg Retrospective Study 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. Baishideng Publishing Group Inc 2017-12-27 2017-12-27 /pmc/articles/PMC5752960/ /pubmed/29359031 http://dx.doi.org/10.4240/wjgs.v9.i12.256 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Retrospective Study Hasan, Shaakir Thai, Ngoc Uemura, Tadahiro Kudithipudi, Vijay Renz, Paul Abel, Stephen Kirichenko, Alexander V Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy |
title | Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy |
title_full | Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy |
title_fullStr | Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy |
title_full_unstemmed | Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy |
title_short | Hepatocellular carcinoma with child Pugh-A Cirrhosis treated with stereotactic body radiotherapy |
title_sort | hepatocellular carcinoma with child pugh-a cirrhosis treated with stereotactic body radiotherapy |
topic | Retrospective Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5752960/ https://www.ncbi.nlm.nih.gov/pubmed/29359031 http://dx.doi.org/10.4240/wjgs.v9.i12.256 |
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