Advertisement

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Current State and Future Opportunities

  • Payal D. SoniEmail author
  • Manisha Palta
Review
  • 19 Downloads

Abstract

Hepatocellular carcinoma is a rising cause of morbidity and mortality in the USA and around the world. Surgical resection and liver transplantation are the preferred management strategies; however, less than 30% of patients are eligible for surgery. Stereotactic body radiation therapy is a promising local treatment option for non-surgical candidates. Local control rates between 95 and 100% have been reported at 1–2 years post-treatment, and classical radiation-induced liver disease described with conventional radiation is an unlikely complication from stereotactic radiotherapy. Enrollment in randomized trials will be essential in establishing the role of stereotactic radiation in treatment paradigms for hepatocellular carcinoma.

Keywords

Stereotactic SBRT Hepatocellular carcinoma HCC Hypofractionated Radiation 

Notes

Compliance with ethical standards

Conflict of interest

Payal D. Soni, MD has no conflict of interest. Manisha Palta, MD has received research support from Merck and Varian. She has received honorarium from Oakstone CME and UptoDate and also received consultant fees from Navigant.

References

  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.CrossRefGoogle Scholar
  2. 2.
    Xu J. Trends in liver cancer mortality among adults aged 25 and Over in the United States, 2000–2016. In: NCHS Data Brief, no 314. Hyattsville, MD, National Center for Health Statistics, 2018; 2018.Google Scholar
  3. 3.
    Ingold JA, Reed GB, Kaplan HS, Bagshaw MA. Radiation hepatitis. Am J Roentgenol Radium Ther Nucl Med. 1965;93:200–208.Google Scholar
  4. 4.
    Dawson LA, Normolle D, Balter JM, McGinn CJ, Lawrence TS, Ten Haken RK. Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys. 2002;53:810–821.CrossRefGoogle Scholar
  5. 5.
    Ben-Josef E, Normolle D, Ensminger WD, et al. Phase II trial of high-dose conformal radiation therapy with concurrent hepatic artery floxuridine for unresectable intrahepatic malignancies. J Clin Oncol. 2005;23:8739–8747.CrossRefGoogle Scholar
  6. 6.
    Dawson LA, McGinn CJ, Normolle D, et al. Escalated focal liver radiation and concurrent hepatic artery fluorodeoxyuridine for unresectable intrahepatic malignancies. J Clin Oncol. 2000;18:2210–2218.CrossRefGoogle Scholar
  7. 7.
    Boda-Heggemann J, Knopf AC, Simeonova-Chergou A, et al. Deep inspiration breath hold-based radiation therapy: a clinical review. Int J Radiat Oncol Biol Phys. 2016;94:478–492.CrossRefGoogle Scholar
  8. 8.
    Giraud P, Morvan E, Claude L, et al. Respiratory gating techniques for optimization of lung cancer radiotherapy. J Thorac Oncol. 2011;6:2058–2068.CrossRefGoogle Scholar
  9. 9.
    Oldrini G, Taste-George H, Renard-Oldrini S, et al. Implantation of fiducial markers in the liver for stereotactic body radiation therapy: feasibility and results. Diagn Interv Imaging. 2015;96:589–592.CrossRefGoogle Scholar
  10. 10.
    Park SH, Won HJ, Kim SY, et al. Efficacy and safety of ultrasound-guided implantation of fiducial markers in the liver for stereotactic body radiation therapy. PLoS One. 2017;12:e0179676.CrossRefGoogle Scholar
  11. 11.
    Bujold A, Massey CA, Kim JJ, et al. Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol. 2013;31:1631–1639.CrossRefGoogle Scholar
  12. 12.
    Lasley FD, Mannina EM, Johnson CS, et al. Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy. Pract Radiat Oncol. 2015;5:e443–e449.CrossRefGoogle Scholar
  13. 13.
    Weiner AA, Olsen J, Ma D, et al. Stereotactic body radiotherapy for primary hepatic malignancies—report of a phase I/II institutional study. Radiother Oncol. 2016;121:79–85.CrossRefGoogle Scholar
  14. 14.
    Feng M, Suresh K, Schipper MJ, et al. Individualized adaptive stereotactic body radiotherapy for liver tumors in patients at high risk for liver damage: a phase 2 clinical trial. JAMA Oncol. 2018;4:40–47.CrossRefGoogle Scholar
  15. 15.
    Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–247.CrossRefGoogle Scholar
  16. 16.
    Culleton S, Jiang H, Haddad CR, et al. Outcomes following definitive stereotactic body radiotherapy for patients with Child-Pugh B or C hepatocellular carcinoma. Radiother Oncol. 2014;111:412–417.CrossRefGoogle Scholar
  17. 17.
    Sakka SG. Assessment of liver perfusion and function by indocyanine green in the perioperative setting and in critically ill patients. J Clin Monit Comput. 2017;32(5):787–796.CrossRefGoogle Scholar
  18. 18.
    Sakka SG, Reinhart K, Meier-Hellmann A. Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients. Chest. 2002;122:1715–1720.CrossRefGoogle Scholar
  19. 19.
    Stenmark MH, Cao Y, Wang H, et al. Estimating functional liver reserve following hepatic irradiation: adaptive normal tissue response models. Radiother Oncol. 2014;111:418–423.CrossRefGoogle Scholar
  20. 20.
    Fukumitsu N, Sugahara S, Nakayama H, et al. A prospective study of hypofractionated proton beam therapy for patients with hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2009;74:831–836.CrossRefGoogle Scholar
  21. 21.
    Bush DA, Kayali Z, Grove R, Slater JD. The safety and efficacy of high-dose proton beam radiotherapy for hepatocellular carcinoma: a phase 2 prospective trial. Cancer. 2011;117:3053–3059.CrossRefGoogle Scholar
  22. 22.
    Hong TS, Wo JY, Yeap BY, et al. Multi-institutional phase II study of high-dose hypofractionated proton beam therapy in patients with localized, unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol. 2016;34:460–468.CrossRefGoogle Scholar
  23. 23.
    Kasuya G, Kato H, Yasuda S, et al. Group LCW: progressive hypofractionated carbon-ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials. Cancer. 2017;123:3955–3965.CrossRefGoogle Scholar
  24. 24.
    Wahl DR, Stenmark MH, Tao Y, et al. Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma. J Clin Oncol. 2016;34:452–459.CrossRefGoogle Scholar
  25. 25.
    Sapir E, Tao Y, Schipper MJ, et al. Stereotactic body radiation therapy as an alternative to transarterial chemoembolization for hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2018;100:122–130.CrossRefGoogle Scholar
  26. 26.
    O’Connor JK, Trotter J, Davis GL, Dempster J, Klintmalm GB, Goldstein RM. Long-term outcomes of stereotactic body radiation therapy in the treatment of hepatocellular cancer as a bridge to transplantation. Liver Transpl. 2012;18:949–954.CrossRefGoogle Scholar
  27. 27.
    Mannina EM, Cardenes HR, Lasley FD, et al. Role of stereotactic body radiation therapy before orthotopic liver transplantation: retrospective evaluation of pathologic response and outcomes. Int J Radiat Oncol Biol Phys. 2017;97:931–938.CrossRefGoogle Scholar
  28. 28.
    Mohamed M, Katz AW, Tejani MA, et al. Comparison of outcomes between SBRT, yttrium-90 radioembolization, transarterial chemoembolization, and radiofrequency ablation as bridge to transplant for hepatocellular carcinoma. Adv Radiat Oncol. 2016;1:35–42.CrossRefGoogle Scholar
  29. 29.
    Sapisochin G, Barry A, Doherty M, et al. Grant DR: stereotactic body radiotherapy vs TACE or RFA as a bridge to transplant in patients with hepatocellular carcinoma: an intention-to-treat analysis. J Hepatol. 2017;67:92–99.CrossRefGoogle Scholar
  30. 30.
  31. 31.
    Habraken SJM, Sharfo AWM, Buijsen J, et al. The TRENDY multi-center randomized trial on hepatocellular carcinoma—trial QA including automated treatment planning and benchmark-case results. Radiother Oncol. 2017;125:507–513.CrossRefGoogle Scholar
  32. 32.
    SBRT or TACE for Advanced HCC. https://clinicaltrials.gov/ct2/show/NCT03338647. Accessed 02 Aug 2018.
  33. 33.
    Comparing Re-TACE Versus SABR for Post-prior-TACE Incompletely Regressed HCC: a Randomized Controlled Trial (TASABR). https://clinicaltrials.gov/ct2/NCT02921139. Accessed 02 Aug 2018.
  34. 34.
    Comparison of SBRT and Repeat TACE for HCC (STH). https://clinicaltrials.gov/ct2/show/NCT03326375. Accessed 02 Aug 2018.
  35. 35.
    Transarterial chemoembolization compared with stereotactic body radiation therapy or stereotactic ablative radiation therapy in treating patients with residual or recurrent liver cancer undergone initial transarterial chemoembolization. https://clinicaltrials.gov/ct2/show/NCT02762266. Accessed 02 Aug 2018.
  36. 36.
    Stereotactic body radiation therapy (SBRT) versus trans-arterial chemoembolization (TACE) as bridge to liver transplant (SBRTvsTACE). https://clinicaltrials.gov/ct2/show/NCT02182687. Accessed 02 Aug 2018.
  37. 37.
    Radiotherapy versus no intervention in adult patients with hepatocellular carcinoma not eligible for transarterial chemoembolization or ablation prior to liver transplant (RADBRI). https://clinicaltrials.gov/ct2/show/NCT03172559. Accessed 02 Aug 2018.
  38. 38.
    Stereotactic body radiotherapy and microwave ablation for recurrent small hepatocellular carcinoma. https://clinicaltrials.gov/ct2/show/NCT03609268. Accessed 02 Aug 2018.
  39. 39.
    Trial comparing PLA to HIGRT therapy (PROVE-HCC). https://clinicaltrials.gov/ct2/show/NCT03402607. Accessed 02 Aug 2018.

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.Radiation Oncology ServiceHunter Holmes McGuire VA Medical CenterRichmondUSA
  2. 2.Department of Radiation OncologyDuke University Medical CenterDurhamUSA

Personalised recommendations