Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Hasan, Shaakir, Thai, Ngoc, Uemura, Tadahiro, Kudithipudi, Vijay, Renz, Paul, Abel, Stephen, Kirichenko, Alexander V
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2017
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
_version_ 1783290177299415040
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
work_keys_str_mv AT hasanshaakir hepatocellularcarcinomawithchildpughacirrhosistreatedwithstereotacticbodyradiotherapy
AT thaingoc hepatocellularcarcinomawithchildpughacirrhosistreatedwithstereotacticbodyradiotherapy
AT uemuratadahiro hepatocellularcarcinomawithchildpughacirrhosistreatedwithstereotacticbodyradiotherapy
AT kudithipudivijay hepatocellularcarcinomawithchildpughacirrhosistreatedwithstereotacticbodyradiotherapy
AT renzpaul hepatocellularcarcinomawithchildpughacirrhosistreatedwithstereotacticbodyradiotherapy
AT abelstephen hepatocellularcarcinomawithchildpughacirrhosistreatedwithstereotacticbodyradiotherapy
AT kirichenkoalexanderv hepatocellularcarcinomawithchildpughacirrhosistreatedwithstereotacticbodyradiotherapy