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Sosorburam T. Predicting Liver Cancer Risk Using Comprehensive Medical History. Qual Manag Health Care 2025; 34:156-163. [PMID: 40163106 DOI: 10.1097/qmh.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
BACKGROUND AND OBJECTIVES Liver cancer mortality is rising faster than any other cancer, significantly impacting life expectancy due to its relatively young median age at diagnosis and high mortality rate. There are currently no consistently recommended screening tests for liver cancer in individuals with a high-risk profile or abnormalities in body systems other than liver disease with cirrhosis. This study aims to screen various body system diseases that might be associated with liver cancer risk. METHODS The study utilized the All of Us database, including 410 361 US-based adults aged 18 and above, of whom 2171 had liver cancer. Least Absolute Shrinkage and Selection Operator regression and logistic regression were used to identify significant predictors and calculate odds ratios (ORs). All statistical analyses were conducted using R software. RESULTS Out of the total participants, 0.5% had liver cancer diagnoses. Male gender and white race were associated with an increased risk of liver cancer (OR = 1.2). Certain diseases were strongly linked to a higher risk of liver cancer, such as liver cirrhosis, chronic steatorrhea, and neoplasms of unknown behavior in the genitourinary organs, each with an OR greater than 8. Digestive disorders, including pancreatic disorders and chronic hepatitis B and C, were also associated with an increased risk of liver cancer (OR > 4). CONCLUSIONS The predictive model has the potential to enhance liver cancer outcomes by effectively targeting at-risk populations and by advocating for early screening among those with high-risk bodily diseases or specific diseases, which could impact survival rates.
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Affiliation(s)
- Tumen Sosorburam
- Author Affiliation: Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, Virginia
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2
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Xuan W, Zhang X, Fang Y, Zhang Y, Xiang Z, Yu Y, Wu Q, Zhang X. Efficacy and safety of neoadjuvant therapy for hepatocellular carcinoma with portal vein thrombosis: A meta‑analysis. Oncol Lett 2025; 29:122. [PMID: 39807096 PMCID: PMC11726279 DOI: 10.3892/ol.2025.14868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 12/05/2024] [Indexed: 01/16/2025] Open
Abstract
Hepatocellular carcinoma (HCC) with coexisting portal vein tumor thrombus (PVTT) is associated with poor patient outcomes. The efficacy and safety of neoadjuvant therapy in patients with HCC with PVTT remain a subject of debate. In the present study, a comprehensive search of electronic databases, including PubMed, Web of Science, Embase and the Cochrane Library, was conducted to identify studies evaluating the outcomes of neoadjuvant therapy in patients with HCC and PVTT. The primary outcomes assessed were overall survival (OS) and relapse-free survival (RFS), with complication rates as a secondary outcome. A total of six studies comprising 750 patients were included in the present meta-analysis. The neoadjuvant therapy group exhibited significantly superior OS [hazard ratio (HR), 0.39; P<0.001] and RFS (HR, 0.31; P<0.001) compared with the primary hepatectomy control group. Compared with the control group, neoadjuvant radiotherapy improved OS (HR, 0.34; P<0.001) and RFS (HR, 0.24; P=0.004). While the neoadjuvant intervention subgroup exhibited an improved OS compared with controls (HR, 0.37; P=0.001), no significant difference in RFS was observed (HR, 0.11; P=0.095). Geographical analysis revealed that the Chinese subgroup demonstrated a significantly improved OS and RFS (HR, 0.41 for both; P<0.001), compared with the control group. However, the Japanese and Korean subgroups showed no improvement in OS (HR, 0.25; P=0.057) compared with the control group, and the results did not reach statistical significance. There were no significant differences between the groups in terms of blood transfusion, blood loss, operation time, bile leakage, ascites, peritoneal infection, postoperative bleeding, complications or mortality (all P>0.05). Overall, neoadjuvant therapy significantly improved survival outcomes in patients with HCC and PVTT without increasing complication rates, supporting its efficacy and manageable safety profile.
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Affiliation(s)
- Wangyi Xuan
- Department of Gastroenterology, Ningbo Zhenhai Hospital of Traditional Chinese Medicine, Ningbo, Zhejiang 315299, P.R. China
| | - Xiaoming Zhang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, P.R. China
| | - Yingying Fang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, P.R. China
| | - Yueming Zhang
- Intensive Care Unit, Hospital of Zhejiang People's Armed Police, Hangzhou, Zhejiang 310051, P.R. China
| | - Zhiyi Xiang
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, P.R. China
| | - Yifei Yu
- School of Stomatology, Zhejiang University of Chinese Medicine, Hangzhou, Zhejiang 310053, P.R. China
| | - Qingping Wu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, P.R. China
| | - Xingfen Zhang
- Department of Liver Disease, Ningbo No. 2 Hospital, Ningbo, Zhejiang 315010, P.R. China
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Shu Q, Zhu J, Mo J, Wei X, Zhu Z, Chen X, He F, Zhong L. Identification and validation of PANoptosis-related LncRNAs prognosis system in hepatocellular carcinoma. Sci Rep 2025; 15:6030. [PMID: 39972122 PMCID: PMC11840146 DOI: 10.1038/s41598-025-90498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 02/13/2025] [Indexed: 02/21/2025] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common solid malignancies in the world. Due to the limited effectiveness of current drug treatments, further research on HCC is necessary. PANoptosis is defined as an inflammatory RCD whose main features combine pyroptosis, apoptosis and necroptosis which cannot be explained by any of these three RCDs alone. In HCC, risk stratification based on PANoptosis-associated lncRNAs has clinical application potential. In this study, we explored HCC related PANoptosis-related lncRNAs (PRLs) by analyzing significantly differentially expressed genes in HCC. HCC-associated PRL scores were established by WGCNA, LASSO analysis and multivariate Cox assessment. Subsequently, we verified the prognostic analysis ability of PRL score for HCC patients, and on this basis established a prognostic risk assessment model for HCC and verified its reliability. The relationship between PRL score and immune infiltration as well as drug sensitivity was further analyzed to evaluate the clinical reference value of this model. Western blot analysis and PCR further verified the reliability of bioinformatics results. The observed suppression of HCC progression and invasiveness following selected PRL knockdown further validated the reliability of our bioinformatics analysis results. Our results provide new evidence for the role of PANoptosis-associated lncRNAs in HCC.
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Affiliation(s)
- Qi Shu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China.
| | - Junfeng Zhu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Jiaping Mo
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Xiaoyan Wei
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Zhenjie Zhu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Xiaojuan Chen
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Fugen He
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China.
| | - Like Zhong
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China.
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Diamond BH, Banson K, Ayash J, Lee P, Shukla UC, Jones G, Rava P, Fitzgerald TJ, Sioshansi S. Outcomes After Stereotactic Body Radiation for Hepatocellular Carcinoma in Patients With Child-Pugh A Versus Child-Pugh B/C Cirrhosis. Adv Radiat Oncol 2024; 9:101631. [PMID: 39559260 PMCID: PMC11570226 DOI: 10.1016/j.adro.2024.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 07/02/2024] [Indexed: 11/20/2024] Open
Abstract
Purpose For patients with hepatocellular carcinoma (HCC), stereotactic body radiation therapy (SBRT) has emerged as a locoregional treatment. Our purpose was to report outcomes in patients with HCC with Child-Pugh A (CP A) versus Child-Pugh B or C (CP B/C) liver dysfunction treated with SBRT. Methods and Materials A retrospective analysis of 80 patients with HCC, with a total of 94 tumors treated with SBRT, was conducted at a single institution. Outcomes were compared between patients with CP A (n = 51) and CP B/C (n = 29) liver dysfunction. Outcomes of interest included local control, overall survival (OS), and toxicity. Results Median tumor size was 3.2 cm. There were 59 tumors included in the CP A cohort and 35 tumors in the CP B/C cohort. Median radiation dose was 50 Gy in 5 fractions for the CP A cohort and 40 Gy in 5 fractions for the CP B/C cohort. The rates of pathologic complete response were similar between the 2 groups at 63% for the CP A group and 61% for the CP B/C group. The estimated 1-year local control rates were similar between the 2 groups at 93% for the CP A group and 91% for the CP B/C group (P = .59). The 1-year OS for the CP A group was 85%, whereas the 1-year OS for the CP B/C group was 61% (P = .19). There was a 5.9% rate of grade 3+ toxicity in the CP A group and a 20.7% rate of grade 3+ toxicity in the CPB/C group. Conclusions Our findings suggest that SBRT is feasible and effective in patients with both CP A and CP B/C liver dysfunction with similar rates of local control and pathologic complete response despite lower radiation doses in the CP B/C cohort. In patients with more advanced CP B/C cirrhosis, toxicities were higher and must be weighed against possible treatment benefits. Further studies characterizing the optimal role of SBRT in patients with advanced cirrhosis are warranted.
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Affiliation(s)
- Brett H. Diamond
- Department of Radiation Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Kara Banson
- Department of Radiation Oncology, New York University, New York, New York
| | - Jonathan Ayash
- Department of Radiation Oncology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Peter Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Gavin Jones
- Department of Radiation Oncology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Paul Rava
- Department of Radiation Oncology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Thomas J. Fitzgerald
- Department of Radiation Oncology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Shirin Sioshansi
- Department of Radiation Oncology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
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Zhong Q, Zhao B, She X, Liu X. HMGA2 as a prognostic and immune biomarker in hepatocellular carcinoma: Comprehensive analysis of the HMG family and experiments validation. PLoS One 2024; 19:e0311204. [PMID: 39591457 PMCID: PMC11594397 DOI: 10.1371/journal.pone.0311204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 09/15/2024] [Indexed: 11/28/2024] Open
Abstract
The molecular mechanisms underlying hepatocellular carcinoma (HCC) are complex and not fully understood. This study aims to explore the expression and clinical significance of High Mobility Group (HMG) proteins in HCC to identify potential prognostic biomarkers and therapeutic targets. Bioinformatic analyses were performed using data from The Cancer Genome Atlas (TCGA) and other databases. Expression levels of HMGs were validated in HCC cell lines using qRT-PCR, and functional studies were conducted by knocking down HMGA2.HMG family members, particularly HMGA1, HMGA2, HMGB2, and HMGN1, were significantly upregulated in HCC tissues compared to normal tissues. High expression levels of these proteins were associated with poor overall survival and disease-specific survival in HCC patients. Knockdown of HMGA2 in HCC cell lines led to reduced cell proliferation, migration, and invasion. HMGA2, along with other HMG family members, emerges as a potential prognostic biomarker and therapeutic target in HCC. This study provides new insights into the role of HMG proteins in HCC progression.
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Affiliation(s)
- Qiangqiang Zhong
- Department of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Laboratory of Metabolic Abnormalities and Vascular Aging Huazhong University of Science and Technology, Wuhan, PR China
| | - Baokang Zhao
- Department of Gastroenterology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Department of Geriatrics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Xiao She
- Department of Gastroenterology, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, PR China
| | - Xiangjie Liu
- Department of Geriatrics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Liu JX, Zhang X, Xu WH, Hao XD. The role of RNA modifications in hepatocellular carcinoma: functional mechanism and potential applications. Front Immunol 2024; 15:1439485. [PMID: 39229278 PMCID: PMC11368726 DOI: 10.3389/fimmu.2024.1439485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/05/2024] [Indexed: 09/05/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is a highly aggressive cancer with a poor prognosis. The molecular mechanisms underlying its development remain unclear. Recent studies have highlighted the crucial role of RNA modifications in HCC progression, which indicates their potential as therapeutic targets and biomarkers for managing HCC. In this review, we discuss the functional role and molecular mechanisms of RNA modifications in HCC through a review and summary of relevant literature, to explore the potential therapeutic agents and biomarkers for diagnostic and prognostic of HCC. This review indicates that specific RNA modification pathways, such as N6-methyladenosine, 5-methylcytosine, N7-methylguanosine, and N1-methyladenosine, are erroneously regulated and are involved in the proliferation, autophagy, innate immunity, invasion, metastasis, immune cell infiltration, and drug resistance of HCC. These findings provide a new perspective for understanding the molecular mechanisms of HCC, as well as potential targets for the diagnosis and treatment of HCC by targeting specific RNA-modifying enzymes or recognition proteins. More than ten RNA-modifying regulators showed the potential for use for the diagnosis, prognosis and treatment decision utility biomarkers of HCC. Their application value for HCC biomarkers necessitates extensive multi-center sample validation in the future. A growing number of RNA modifier inhibitors are being developed, but the lack of preclinical experiments and clinical studies targeting RNA modification in HCC poses a significant obstacle, and further research is needed to evaluate their application value in HCC treatment. In conclusion, this review provides an in-depth understanding of the complex interplay between RNA modifications and HCC while emphasizing the promising potential of RNA modifications as therapeutic targets and biomarkers for managing HCC.
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Affiliation(s)
- Jin-Xiu Liu
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
| | - Xiaoping Zhang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wen-Hua Xu
- Institute of Regenerative Medicine and Laboratory Technology Innovation, Qingdao University, Qingdao, Shandong, China
| | - Xiao-Dan Hao
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
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Hallsworth K, McCain MV, Fallen-Bailey R, Brown MC, Orange ST, Reeves HL. Is home-based, virtually delivered, group exercise feasible and acceptable for older patients with hepatocellular carcinoma? A non-randomised feasibility study (TELEX-Liver Cancer). BMJ Open 2024; 14:e082155. [PMID: 38866571 PMCID: PMC11177682 DOI: 10.1136/bmjopen-2023-082155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/20/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES The study aimed to assess the feasibility, acceptability and safety of delivering a home-based telehealth exercise intervention to older patients with hepatocellular carcinoma (HCC). DESIGN Non-randomised feasibility study. SETTING Patients were recruited from UK outpatient liver cancer clinics. PARTICIPANTS Patients were aged ≥60 years with HCC, with post-treatment imaging reporting a complete response, partial response or stable disease. INTERVENTION AND DATA COLLECTION Patients were invited to attend synchronous online exercise sessions, twice weekly for 10 weeks. Physical function and patient-reported outcomes were assessed pre-intervention and post-intervention. Qualitative data were collected via semistructured interviews after intervention completion. PRIMARY OUTCOME MEASURES Recruitment, retention, exercise adherence and safety. RESULTS 40 patients were invited to participate and 19 (mean age 74 years) provided consent (recruitment rate 48%). Patients completed 76% of planned exercise sessions and 79% returned to the clinic for follow-up. Hand grip strength (95% CI 1.0 to 5.6), Liver Frailty Index (95% CI -0.46 to -0.23) and time taken to perform five sit-to-stands (95% CI -3.2 to -1.2) improved from pre-intervention to post-intervention. Patients reported that concerns they had relating to their cancer had improved following the intervention (95% CI 0.30 to 5.85). No adverse events occurred during exercise sessions.Qualitative data highlighted the importance of an instructor in real time to ensure that the sessions were achievable, tailored and well balanced, which helped to foster motivation and commitment within the group. Patients reported enjoying the exercise intervention, including the benefits of peer support and highlighted perceived benefits to both their physical and mental health. Patients felt that the online sessions overcame some of the barriers to exercise participation and preferred attending virtual sessions over face-to-face classes. CONCLUSIONS It is feasible, acceptable and safe to deliver supervised group exercise via videoconferencing to patients with HCC in their own homes. These findings will inform the design of a future, adequately powered randomised controlled trial to evaluate the efficacy of the intervention. TRIAL REGISTRATION NUMBER ISRCTN14411809.
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Affiliation(s)
- Kate Hallsworth
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- The Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Misti V McCain
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | | | - Morven C Brown
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Samuel T Orange
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences,Newcastle University, Newcastle upon Tyne, UK
| | - Helen L Reeves
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- The Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
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Nisha A, C S, Nagesh J, Nair SS. Comparison between Volumetric Modulated arc Therapy based Coplanar and Noncoplanar Planning for Stereotactic Body Radiation Therapy of Liver. Asian Pac J Cancer Prev 2024; 25:1383-1390. [PMID: 38680000 PMCID: PMC11162725 DOI: 10.31557/apjcp.2024.25.4.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/14/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND The study aims to investigate potential dosimetric benefits between non-coplanar and coplanar beam arrangements of Volumetric-Modulated Arc Therapy (VMAT) plans for liver stereotactic body radiotherapy (SBRT). METHODS Thirteen patients who had undergone liver SBRT treatment in our department were chosen retrospectively for the study. Two sets of SBRT-VMAT plans namely, non-coplanar (NC-VMAT) and Coplanar (C-VMAT) were generated in Monaco(v5.11) planning system for Elekta Versa HD Linac using unflatten 6MV photon. The NC-VMAT plans were created by two/three non-coplanar partial arcs with couch rotation of ±150 and had an arc span of 1300 to 1600 whereas the C-VMAT plans consisted of a full arc. Both plans were compared by statistically analyzing various dosimetric and technical parameters. RESULTS There is no statistically significant difference observed between the C-VMAT and NC-VMAT plans for planning target volume (PTV) coverage. However, the spine dose (D1cc) was much less in the NC-VMAT plan compared to the C-VMAT plan, with mean values of 6.127 ± 3.08Gy and 9.058 ± 4.76Gy, respectively (p-value=0.002). The low dose spillage to the healthy tissue was compared by the volume receiving 5Gy (V5Gy) and 10Gy (V10Gy). V5Gy of the NC-VMAT plan was 2399.23±1870.76cc while that of C-VMAT plans was 2835.36±1930.20cc with the p-value <0.001. Moreover, the monitor units(MU) were less with NC-VMAT than with C-VMAT SBRT plans (p=0.015). CONCLUSION The plan quality of NC-VMAT plans was favorable compared to C-VMAT plans for liver SBRT especially in reducing spine dose, low dose spillage to healthy tissue, and MU.
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Affiliation(s)
- Anjum Nisha
- Department of Radiotherapy and Oncology, Medical Radiation Physics Program, Manipal College of Health Professions(MCHP), Manipal Academy of Higher Education(MAHE), Manipal, Karnataka, India.
| | - Shambhavi C
- Department of Radiotherapy and Oncology, Medical Radiation Physics Program, Manipal College of Health Professions(MCHP), Manipal Academy of Higher Education(MAHE), Manipal, Karnataka, India.
| | - Jyothi Nagesh
- Radiotherapy and Oncology, Senior Grade Lecturer, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Sarath S Nair
- Radiotherapy and Oncology, Senior Grade Lecturer, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Bidarmaghz B, Idrees M, Lee YY, Hodgkinson P. Large hepatocellular carcinoma treated with sequential SBRT and immunotherapy with anti-VEGF (Vascular Endothelial Growth Factor) therapy. BMJ Case Rep 2023; 16:e256931. [PMID: 38061854 PMCID: PMC10711845 DOI: 10.1136/bcr-2023-256931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
Managing large solitary hepatocellular carcinoma (HCC) remains challenging as guidelines recommend a palliative approach given the general poor prognosis without accounting for variations in the underlying tumour biology. Surgical resection provides significantly better survival than other modalities for HCC, but only a small proportion of patients with large tumours qualify for surgical resection. Recently, with technological advances in radiation therapy, stereotactic body radiation therapy (SBRT) has emerged as an alternative treatment option for HCC . In this paper, we present a patient who was diagnosed with a 13 cm HCC with vascular invasion. SBRT was delivered as a locoregional therapy followed by immunotherapy with the outcome of complete pathological response observed on right hemi-hepatectomy.
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Affiliation(s)
- Bardia Bidarmaghz
- Transplant, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Marwan Idrees
- Transplant, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Yoo Young Lee
- Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Peter Hodgkinson
- Transplant, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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10
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Singal AG, Özgürdal K, Fan X, Vassilev Z, Pan X, Multani JK, Chen CC, Zhou Z, He J, Pisa F. Real-World Systemic Treatment Patterns after Atezolizumab and Bevacizumab in Patients with Hepatocellular Carcinoma in the United States. Cancers (Basel) 2023; 15:5532. [PMID: 38067235 PMCID: PMC10705135 DOI: 10.3390/cancers15235532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2025] Open
Abstract
Real-world (RW) evidence is needed to evaluate atezolizumab plus bevacizumab (atezo + bev) utilization for hepatocellular carcinoma (HCC) in clinical practice. This retrospective cohort study used administrative claims databases to evaluate treatment patterns in individuals with HCC ≥18 years of age who were initiated on atezo + bev between June 2020 and June 2022. The endpoints of this study were the proportion of individuals who discontinued atezo + bev and received subsequent systemic therapies, time to discontinuation (TTD), and time to next treatment. Overall, 825 individuals were eligible (median age 67 years; 80% male). Over a median follow-up of 15.3 months, most (72%) discontinued atezo + bev, with a median TTD of 3.5 months. A minority (19%) received subsequent therapies, with the most common second-line agents being lenvatinib (6%), cabozantinib (4%), and nivolumab (4%). The median time from index to next treatment post-atezo + bev was 5.4 months. Further research is needed to identify the patients who are most likely to benefit from atezo + bev as well as later-line HCC therapies to optimize overall survival.
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Affiliation(s)
- Amit G. Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kirhan Özgürdal
- Medical Affairs Oncology, Bayer Consumer Care AG, 4052 Basel, Switzerland
| | - Xiaozhou Fan
- Oncology RWE, Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ 07981, USA
| | - Zdravko Vassilev
- Oncology RWE, Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ 07981, USA
| | - Xiaoyun Pan
- Global Outcomes Research Department, Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ 07981, USA
| | - Jasjit K. Multani
- Health Economics and Outcomes Research, Real World Evidence Solutions, IQVIA US, Falls Church, VA 22042, USA
| | - Chi-Chang Chen
- Health Economics and Outcomes Research, Real World Evidence Solutions, IQVIA US, Wayne, PA 19087, USA
| | - Zifan Zhou
- Health Economics and Outcomes Research, Real World Evidence Solutions, IQVIA US, Wayne, PA 19087, USA
| | - Jing He
- Advanced Analytics, IQVIA US, Plymouth Meeting, PA 19462, USA
| | - Federica Pisa
- Real World Evidence Oncology, Bayer AG, 13342 Berlin, Germany;
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Suresh D, Srinivas AN, Prashant A, Harikumar KB, Kumar DP. Therapeutic options in hepatocellular carcinoma: a comprehensive review. Clin Exp Med 2023; 23:1901-1916. [PMID: 36780119 DOI: 10.1007/s10238-023-01014-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/27/2023] [Indexed: 02/14/2023]
Abstract
Hepatocellular carcinoma (HCC) is a chronic liver disease that is highly fatal if not detected and treated early. The incidence and death rate of HCC have been increasing in recent decades despite the measures taken for preventive screening and effective diagnostic and treatment strategies. The pathophysiology of HCC is multifactorial and highly complex owing to its molecular and immune heterogeneity, and thus the gap in knowledge still precludes making choices between viable therapeutic options and also the development of effective regimens. The treatment of HCC demands multidisciplinary approaches and primarily depends on tumor stage, hepatic functional reserve, and response to treatment by patients. Although curative treatments are limited but critical in the early stages of cancer, there are numerous palliative treatments available for patients with intermediate and advanced-stage HCC. In recent times, the use of combination therapy has succeeded over the use of monotherapy in the treatment of HCC by achieving effective tumor suppression, increasing survival rate, decreasing toxicity, and also aiding in overcoming drug resistance. This work focuses on reviewing the current and emerging treatment strategies for HCC.
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Affiliation(s)
- Diwakar Suresh
- Department of Biochemistry, CEMR, JSS Medical College, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, India
| | - Akshatha N Srinivas
- Department of Biochemistry, CEMR, JSS Medical College, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, India
| | - Akila Prashant
- Department of Biochemistry, CEMR, JSS Medical College, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, India
| | - Kuzhuvelil B Harikumar
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, 695014, India
| | - Divya P Kumar
- Department of Biochemistry, CEMR, JSS Medical College, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, India.
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12
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Tanaka T, Takata K, Miyayama T, Shibata K, Fukuda H, Yamauchi R, Fukunaga A, Yokoyama K, Shakado S, Sakisaka S, Hirai F. Long-term outcome and eligibility of radiofrequency ablation for hepatocellular carcinoma over 3.0 cm in diameter. Sci Rep 2023; 13:16286. [PMID: 37770523 PMCID: PMC10539460 DOI: 10.1038/s41598-023-43516-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023] Open
Abstract
Percutaneous radiofrequency ablation (RFA) is effective for the treatment of small hepatocellular carcinoma (HCC) with a diameter ≤ 3.0 cm. The present study aimed to elucidate the prognostic factors and clarify the indication of treatment for RFA outcomes in patients with HCC with a diameter > 3.0 cm. Among 2188 patients with HCC who underwent RFA, 100 patients with HCC with a diameter > 3.0 cm were enrolled in this study between August, 2000 and August, 2021. We analyzed local therapeutic efficacy, long-term outcomes, and prognostic factors in patients with HCC with a diameter > 3.0 cm. Among all patients, 77 patients achieved complete ablation in one session. There were no treatment-related deaths or major complications. Local tumor recurrence occurred in 48% (n = 48) of the patients, and distant tumor recurrence occurred in 82% (n = 82) of the patients during the study period. The survival rates at 1-, 3-, 5-, 10-, and 15- years were 93.0%, 66.0%, 40.0%, 15.5%, and 10.2%, respectively. Cox proportional hazards regression analysis confirmed that distant tumor recurrence, Child-Pugh class B, and pre-ablation des-γ-carboxy prothrombin (DCP) levels ≥ 200 mAU/mL were independent unfavorable prognostic factors with a hazard ratio of 3.34 (95% CI, 1.57-7.11; P = 0.002), 2.43 (95% CI, 1.35-4.37; P = 0.003), and 1.83 (95% CI, 1.14-2.93; P = 0.012), respectively. In conclusion, patients with HCC with a diameter > 3.0 cm with Child-Pugh class A and DCP levels < 200 mAU/mL might be eligible for RFA treatment.
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Affiliation(s)
- Takashi Tanaka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan.
| | - Kazuhide Takata
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Takashi Miyayama
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Kumiko Shibata
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Hiromi Fukuda
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Ryo Yamauchi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Atsushi Fukunaga
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Keiji Yokoyama
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Satoshi Shakado
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Shotaro Sakisaka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jonan-Ku, Fukuoka, 814-0180, Japan
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13
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Coffin P, He A. Hepatocellular Carcinoma: Past and Present Challenges and Progress in Molecular Classification and Precision Oncology. Int J Mol Sci 2023; 24:13274. [PMID: 37686079 PMCID: PMC10487618 DOI: 10.3390/ijms241713274] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common solid tumor malignancies in the world and represents roughly 90% of all primary malignancies of the liver. The most common risk factors for HCC include hepatitis B virus, hepatitis C virus, alcohol, and increasingly, fatty liver. Most HCC is diagnosed at advanced stages, excluding the possibility of curative resection, which leaves systemic therapy as the only treatment option. However, given the extreme mutational diversity and heterogenous nature of HCC, efforts to develop new targeted systemic therapies were largely unsuccessful until recently. HCC pathogenesis is thought to be a multistage process driven by a wide array of nonmutually exclusive driver mutations accompanied by many passenger mutations, with the average tumor possessing approximately 40 genomic aberrations. Over the past two decades, several efforts to categorize HCC prognostically and therapeutically according to different molecular subclassifications with the intent to guide treatment and identify drug targets have emerged, though, no single consensus has been reached. Recent breakthroughs in drug development have greatly expanded treatment options, but the ideal of uniting each patient's unique HCC with a targeted systemic therapy remains elusive.
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Affiliation(s)
- Philip Coffin
- MedStar Georgetown University Hospital, Lombardi Cancer Center, 3800 Reservoir Rd NW, Washington, DC 20007, USA;
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14
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Roy P, Parthasarathy KM. Prolonged response to Tyrosine Kinase Inhibitors followed by Immunotherapy in metastatic hepatocellular carcinoma: A rare case report. J Cancer Res Ther 2023; 19:1457-1461. [PMID: 37787330 DOI: 10.4103/jcrt.jcrt_1251_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
The overall prognosis of hepatocellular carcinoma (HCC) is dismal and 5-year survival rate is 14.8%. We report a case of HCC coinfected with hepatitis C virus (HCV) and tumor thrombosis in the portal vein that was initially started on sorafenib followed by lenvatinib and nivolumab. On radiological imaging, there was a good partial response (PR) after starting nivolumab. A female 56 years of age presented with HCC coinfection with HCV, tumor thrombosis growing to the right portal vein. She received 6 months of sorafenib starting from April 2019 and was then switched to lenvatinib due to progressive disease. She continued lenvatinib for 11 months following which she developed new metastatic lesions where she was started on nivolumab. After 4 months of nivolumab, her alpha-fetoprotein decreased and there was a radiological PR. She is currently on nivolumab, with a total duration of response of 24 months on sorafenib followed by lenvatinib and lastly on nivolumab. Hence, tyrosine kinase inhibitors and immunotherapy can be effective lines treatment for advanced HCC and can give durable response duration, and probable radiological PR can be achieved with Nivolumab.
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Affiliation(s)
- Parag Roy
- Department of Medical Oncology, Dharamshila Narayana Superspeciality Hospital, Delhi, India
| | - K M Parthasarathy
- Department of Medical Oncology Senior Consultant and Head Dharamshila Narayana Superspeciality Hospital Vasundhara Enclave, Near New Ashok Nagar Metro Station, New Delhi, Delhi, India
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15
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Podlasek A, Abdulla M, Broering D, Bzeizi K. Recent Advances in Locoregional Therapy of Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:3347. [PMID: 37444457 PMCID: PMC10341377 DOI: 10.3390/cancers15133347] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is responsible for 90% of primary hepatic cancer cases, and its incidence with associated morbidity and mortality is growing worldwide. In recent decades, there has been a revolution in HCC treatment. There are three main types of locoregional therapy: radiofrequency ablation, transarterial chemoembolisation, and transarterial radioembolisation. This article summarises recent advances in locoregional methods.
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Affiliation(s)
- Anna Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), University of Dundee, Dundee DD1 4HN, UK;
- Precision Imaging Beacon, Radiological Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Maheeba Abdulla
- Salmaniya Medical Complex, Arabian Gulf University, Manama 323, Bahrain
| | - Dieter Broering
- Department of Liver Transplantation, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Khalid Bzeizi
- Department of Liver Transplantation, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
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16
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Yadawa N, Shahi UP, Mandal A, Verma A, Kumari K, Aggrawal LM, Jaiswal I, Mourya A, Jaiswal AK, Srivastava P. Percutaneous high-dose-rate interstitial brachytherapy for non-resectable, chemo resistant malignant lesion of lung and liver. J Cancer Res Ther 2023; 19:S807-S814. [PMID: 38384060 DOI: 10.4103/jcrt.jcrt_1351_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/17/2022] [Indexed: 02/23/2024]
Abstract
PURPOSE To explore the feasibility and efficacy of interstitial brachytherapy application for nonresectable and chemo-resistant malignant liver and lung lesions. MATERIALS AND METHODS Percutaneous high-dose-rate interstitial brachytherapy (HDR ISBT) was applied in nine lesions of seven middle-aged patients with advanced carcinoma (five patients with liver lesion and two patients with lung lesion). All patients were surgically ineligible. All patients had already received systemic chemotherapy. Under computed tomography (CT) guidance (for lung lesion) or ultrasonography (USG) guidance (for liver lesion), a single stainless steel brachytherapy needle was inserted percutaneously in patients with lesion size ≤4 centimeter (cm) and multiple needles were inserted in patients of lesion size >4cm. A single dose of 15 Gy to 20 Gy with HDR ISBT was prescribed at the periphery of the lesion. The needles were removed just after treatment. Patients were kept under observation for 24 h after treatment. RESULTS The median size of the lesion was 6.5 cm. In all the cases of liver lesion, more than 75% shrinkage of tumor volume in follow-up at 6 mo was observed. It was more than 50% for lung lesion. None of the patients had developed significant complications as on the median follow up period of 15 mo (ranges 3-27 mo). CONCLUSIONS Percutaneous CT-guided high-dose-rate interstitial brachytherapy is a minimally invasive, safe, and feasible treatment option with minimal complication for inoperable, chemo resistant, advanced cancers with encouraging treatment outcomes.
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Affiliation(s)
- Nandlal Yadawa
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Uday P Shahi
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Abhijit Mandal
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis, IMS BHU Varanasi, Uttar Pradesh, India
| | - Kiran Kumari
- Department of Radiodiagnosis, DMCH, Darbhanga, Bihar, India
| | - Lalit M Aggrawal
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Isha Jaiswal
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Ankur Mourya
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Anil K Jaiswal
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
| | - Pammy Srivastava
- Department of Radiation Oncology, IMS BHU Varanasi, Uttar Pradesh, India
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17
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Nguyen ALT, Blizzard CL, Yee KC, Palmer AJ, de Graaff B. Survival of primary liver cancer for people from culturally and linguistically diverse backgrounds in Australia. Cancer Epidemiol 2022; 81:102252. [PMID: 36116274 DOI: 10.1016/j.canep.2022.102252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Survival for Primary Liver Cancer (PLC) has been investigated in Australia, but limited work has been conducted on the burden for people with different socioeconomic status, region of residence, causes of PLC, and culturally and linguistically diverse (CALD) backgrounds. This study aimed to cover this gap in the literature by investigating PLC survival with the aforementioned factors. METHODS This study linked four administrative datasets: Victorian Cancer Registry, Admitted Episodes Dataset, Emergency Minimum Dataset, and Death Index. The cohort was all cases with a PLC notification within the Victorian Cancer Registry between 01/01/2008 and 01/01/2016. The Kaplan-Meier method was used to estimate survival probabilities and the log-rank test was used to compare the difference in survival between subgroups. The Cox proportional hazard model was used to explore factors associated with PLC survival. RESULTS The 1-, 3- and 5-year survival rates were 50.0%, 28.1% and 20.6%, respectively, with a median survival of 12.0 months (95% confidence interval (CI): 11.0 - 12.9 months). Higher survival was associated with younger age, hepatocellular carcinoma, and higher socio-economic status. People born in Asian, African, and American regions had higher survival than those born in Australia and New Zealand. Cases with viral hepatitis as an identified aetiology had higher survival than those whose PLC was related to alcohol consumption (hazard ratio=1.52, 95% CI: 1.19 - 1.96), diabetes and fatty liver disease (hazard ratio=1.35, 95% CI: 1.08 - 1.68). CONCLUSION Survival outcomes for people diagnosed with PLC were still poor and affected by many factors. Asian and African cases had better survival than Australian and New Zealand patients as PLC in Asian and African cases was mostly caused by viral hepatitis. Metropolitan areas were associated with a higher survival than rural areas, not only due to accessibility to surveillance and healthcare services but also because the majority of overseas-born patients reside in metropolitan areas.
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Affiliation(s)
- Anh Le Tuan Nguyen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia.
| | | | - Kwang Chien Yee
- School of Medicine, University of Tasmania, Hobart, TAS 7000, Australia; Royal Hobart Hospital, Hobart, TAS 7000, Australia..
| | - Andrew John Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia.
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia.
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18
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Goyal P, Salem R, Mouli SK. Role of interventional oncology in hepatocellular carcinoma: Future best practice beyond current guidelines. Br J Radiol 2022; 95:20220379. [PMID: 35867889 PMCID: PMC9815732 DOI: 10.1259/bjr.20220379] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally. Liver transplant remains the goal of curative treatment, but limited supply of organs decreases accessibility and prolongs waiting time to transplantation. Therefore, interventional oncology therapies have been used to treat the majority of HCC patients, including those awaiting transplant. The Barcelona Clinic Liver Cancer (BCLC) classification is the most widely used staging system in management of HCC that helps allocate treatments. Since its inception in 1999, it was updated for the fifth time in November 2021 and for the first time shaped by expert opinions outside the core BCLC group. The most recent version includes additional options for early-stage disease, substratifies intermediate disease into three groups, and lists alternates to Sorafenib that can double the expected survival of advanced-stage disease. The group also proposed a new BCLC staging schema for disease progression, and endorsed treatment stage migration (TSM) directly into the main staging and treatment algorithm. This article reviews the recent developments underlying the current BCLC guidelines and highlights ongoing research, particularly involving radioembolization, that will shape future best practice.
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Affiliation(s)
- Piyush Goyal
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Samdeep K. Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
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19
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Chang SH, Kim TS, Jeon YH, Jung NH, Choi DH. Novel management of expected post-radiotherapy complications in hepatocellular carcinoma patients: a case report. JOURNAL OF LIVER CANCER 2022; 22:183-187. [PMID: 37383411 PMCID: PMC10035741 DOI: 10.17998/jlc.2022.08.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/01/2022] [Accepted: 08/03/2022] [Indexed: 06/30/2023]
Abstract
In recent years, radiotherapy (RT) has been used to treat hepatocellular carcinoma (HCC) at each stage. This clinical trend has developed with the increasing improvement of RT techniques, which show clinical results comparable to those of other treatment modalities. Intensity-modulated radiotherapy uses a high radiation dose to improve treatment effectiveness. However, the associated radiation toxicity can damage adjacent organs. Radiation-induced gastric damage with gastric ulcers is a complication of RT. This report presents a novel management strategy for preventing post-RT gastric ulcers. We present the case of a 53-year-old male patient diagnosed with HCC, who experienced gastric ulcer after RT. Before the second round of RT, the patient was administered a gas-foaming agent, which was effective in preventing RT complications.
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Affiliation(s)
- Sung Hoon Chang
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Tae Suk Kim
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yong Hwan Jeon
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Nuri Hyun Jung
- Department of Radiation Oncology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Dae Hee Choi
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
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20
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Chadow D, Haser P, Aggarwal A, Perezgrovas-Olaria R, Soletti G, Lau C, Castillo R, Jaswani V, Gaudino M, Chadow H. Aspiration thrombectomy for inferior vena cava tumor thrombus arising from hepatocellular carcinoma. J Vasc Surg Cases Innov Tech 2022; 8:538-541. [PMID: 36081743 PMCID: PMC9445887 DOI: 10.1016/j.jvscit.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Pharmacomechanical therapy and catheter-directed thrombolysis have been shown to be very effective in the treatment of venous thromboembolism; however, there is much less data regarding inferior vena cava thrombi. Tumor thrombi pose an even greater clinical challenge as anti-coagulation and thrombolysis are not effective. We present the case of a 61-year-old male who presented with an inferior vena cava thrombus emanating from an accessory right hepatic vein, treated with aspiration thrombectomy.
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21
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Orr CE, Wang PL, Chen L, Wang T. Features of fibrosis regression abound in “non-cirrhotic” patients with resected hepatocellular carcinoma. PLoS One 2022; 17:e0267474. [PMID: 35552548 PMCID: PMC9098014 DOI: 10.1371/journal.pone.0267474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Cirrhosis is a major risk factor for developing hepatocellular carcinoma (HCC). However, many surgically resected HCCs are presumably non-cirrhotic. The dynamic nature of chronic liver disease leads to periods of hepatic repair and fibrosis regression. We hypothesize that most resected HCCs, including those from non-cirrhotic patients, exhibit features of fibrosis regression in their background liver, suggesting previously more advanced liver disease. We reviewed the histology of 37 HCC resections performed between 2005–2020, including 30 from non-cirrhotic patients. The non-neoplastic liver was evaluated for features of liver disease and of the hepatic repair complex (HRC). CD34 immunohistochemistry was performed as a marker of sinusoidal capillarization. CD34 staining was evaluated manually and also by a digital image classifier algorithm. Overall, 28 cases (76%) had a high number of fibrosis regression and hepatic repair features (≥4 out of 8 features). Amongst the 30 non-cirrhotic patients, 21 (70%) showed a high number of repair features. Relative CD34 expression was increased in cases with a high number (≥4) of HRC features versus a low number (≤3) of features (p = 0.019). High HRC cases were more likely to exhibit nodular circumferential CD34 staining (p = 0.019). Our findings suggest that most resected HCC from non-cirrhotic patients display features of fibrosis regression in their background liver. Thus many, if not most, HCC patients who are “non-cirrhotic” may in fact have regressed cirrhosis. This finding reinforces that patients with regressed cirrhosis continue to be at high risk for HCC.
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Affiliation(s)
- Christine E. Orr
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Peter L. Wang
- Department of Medicine, Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
| | - Lina Chen
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tao Wang
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
- * E-mail:
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22
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Masuda S, Tsukiyama T, Minagawa Y, Koizumi K, Kako M, Kinbara T, Haruki U. Hepatocellular carcinoma effective stereotactic body radiotherapy using Gold Anchor and the Synchrony system: Two case reports and review of literature. World J Clin Cases 2022; 10:2591-2603. [PMID: 35434047 PMCID: PMC8968590 DOI: 10.12998/wjcc.v10.i8.2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/12/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
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-Ⅱ levels decreased.
CONCLUSION SBRT using the Synchrony system and GA can deliver a large dose accurately and safely, and could have a high therapeutic effect.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Toshitaka Tsukiyama
- Department of Interventional Radiology Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Yumiko Minagawa
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Makoto Kako
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Takeshi Kinbara
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
| | - Uojima Haruki
- Department of Gastroenterology, Shonankamakura General Hospital, Kanagawa 247-8533, Japan
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Radiofrequency Ablation for Liver: Comparison between Expert Eye and Hyperspectral Imaging Assessment. Photodiagnosis Photodyn Ther 2021; 37:102699. [PMID: 34942401 DOI: 10.1016/j.pdpdt.2021.102699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022]
Abstract
Liver/hepatic cancer (HC) is a disease that roughly afflicts 10% of cancer patients worldwide. HC is in charge of the death of 0.8 million patients on the earth. Multiple approaches, including thermal ablation, target the treatment of HC. In this study, we investigated radiofrequency (RF) ablation. Expert clinicians' visual assessment (VA) dominantly evaluated the outcome of ablation. Inattentively, the disfavors of VA are being subjective and eye-acuity dependent. In support, we propose hyperspectral imaging (HSI) for objective assessment of liver ablation. To verify our proposal, we computed the ablated liver area using VA and HSI. Unfortunately, HSI is a time-intensive technique. To make it less intensive, we present a way of reducing data analysis time. Saving time permits medical decisions, likewise continue or stop RF ablation, to be taken safer and faster. The way to reduce the time for HSI data analysis depends on narrowing the spectral bands of interest to only the most relevant ones to liver chromophores. Liver chromophores change in concentration because of thermal ablation. VA hardly senses these changes, however, HSI does it. Ultimately, the spectral band centered at 630 nm is optimal for objectively support RF ablation decision-makers.
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24
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Chen LC, Lin HY, Lee MS, Chiou WY, Huang LW, Chew CH, Hsu FC, Hung SK. Effectiveness of individual audio-visual coaching, respiratory modulated stereotactic body radiotherapy for localized hepatocellular carcinoma: Analysis of 29 cases from a single academic radiotherapy center. Tzu Chi Med J 2021; 33:380-387. [PMID: 34760635 PMCID: PMC8532585 DOI: 10.4103/tcmj.tcmj_247_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/22/2020] [Accepted: 03/04/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: Recently, Stereotactic Body Radiotherapy (SBRT) has been suggested for managing hepatocellular carcinoma (HCC) curatively. Thus, we conducted this clinical study to evaluate retrospectively the effect of individualized audio-visual (AV) coaching, respiratory modulated SBRT. Materials and Methods: Between 2014 and 2018, 29 patients with inoperable Barcelona Clinic Liver Cancer (BCLC) stage 0-B HCC received AV coaching, respiratory-modulated SBRT. We constructed a task-oriented multidisciplinary team to establish a standard operation process of respiratory modulation procedures and developed our AV coaching devices. In the training period, a goodness-of-fit test was applied individually. SBRT was delivered with a total dose of 40–54 Gy in 5–6 fractions individually. Freedom from local progression (FFLP) and overall survival (OS) were estimated using SPSS (version 17, SPSS Inc., Chicago, IL, USA) life tables. Results: The patient characteristics were as follows: 32.7 ± 16 mm in maximum tumor diameter (range 11–94); BCLC stage 0: 3.4%, BCLC A: 48.3%, BCLC B: 48.3%; Child-Pugh classification A: 86.2%, Child-Pugh classification B: 13.8%, and a median of 2 prior liver-directed treatments (range 0–7). One-, 2-, and 3-year rates of FFLP of SBRT were 96.6%, 96.6%, and 96.6%, respectively. One-, 2-, and 3-year rates of OS were 81.5%, 72.4%, and 67.2%, respectively. No adverse event (AE) occurred in 41.4% of patients, 48.3% developed grade (G) 1–2 AE, 10.3% had G3 AE and none had G4-5 AE. Conclusion: Respiration-modulated SBRT is a promising noninvasive treatment option for patients with inoperable and localized HCC. Our data show that SBRT provides comparable tumor control to historical curative options like surgery and radiofrequency ablation of localized tumors. Thus, we are conducting a further prospective clinical trial with the intent to demarcate the clinical effectiveness of SBRT in a larger population of patients with HCC.
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Affiliation(s)
- Liang-Cheng Chen
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Hon-Yi Lin
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Institute of Molecular Biology, National Chung Cheng University, Chiayi, Taiwan
| | - Moon-Sing Lee
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wen-Yen Chiou
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Li-Wen Huang
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Chia-Hui Chew
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Feng-Chun Hsu
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Shih-Kai Hung
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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25
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Abousaida B, Seneviratne D, Hoppe BS, Ko SJ, Asaithamby A, Cucinotta FA, Kirwan JM, Mody K, Toskich B, Ashman JB, Hallemeier CL, Krishnan S. Carbon Ion Radiotherapy in the Management of Hepatocellular Carcinoma. J Hepatocell Carcinoma 2021; 8:1169-1179. [PMID: 34595139 PMCID: PMC8478421 DOI: 10.2147/jhc.s292516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023] Open
Abstract
Localized hepatocellular carcinoma (HCC) that is unresectable and non-transplantable can be treated by several liver-directed therapies. External beam radiation therapy (EBRT) is an increasingly accepted and widely utilized treatment modality in this setting. Accelerated charged particles such as proton beam therapy (PBT) and carbon ion radiation therapy (CIRT) offer technological advancements over conventional photon radiotherapy. In this review, we summarize the distinct advantages of CIRT use for HCC treatment, focusing on physical and biological attributes, and outline dosimetric and treatment planning caveats. Based on these considerations, we posit that HCC may be among the best indications for use of CIRT, as it allows for maximizing tumoricidal doses to the target volume while minimizing the dose to the organs at risk.
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Affiliation(s)
- Belal Abousaida
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Aroumougame Asaithamby
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Francis A Cucinotta
- School of Integrated Health Sciences, University of Las Vegas, Las Vegas, NV, USA
| | - Jessica M Kirwan
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Kabir Mody
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Beau Toskich
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
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26
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Strainiene S, Sedleckaite K, Jarasunas J, Savlan I, Stanaitis J, Stundiene I, Strainys T, Liakina V, Valantinas J. Complicated course of biliary inflammatory myofibroblastic tumor mimicking hilar cholangiocarcinoma: A case report and literature review. World J Clin Cases 2021; 9:6155-6169. [PMID: 34368338 PMCID: PMC8316968 DOI: 10.12998/wjcc.v9.i21.6155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/30/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The inflammatory myofibroblastic tumor (IMT) is a rare, idiopathic, usually benign, mass-forming disease with myofibroblastic proliferation and a varying amount of inflammatory cells. Although it can affect various organs, the biliary tract is a rare localization of primary IMT, clinically, endoscopically and radiologically imitating cholangiocarcinoma. The treatment options are based only on clinical practice experience. CASE SUMMARY A 70-year-old woman was referred to our center due to progressive fatigue, weight loss, abdominal pain, night sweats, and elevated liver enzymes. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) revealed proximal common hepatic duct and hilar biliary strictures extending bilaterally to lobular bile ducts. Although initial clinical, endoscopic and radiological signs were typical for hilar cholangiocarcinoma, histological examination showed no signs of malignancy. In total, 8 biopsies using different approaches were performed (several biopsies from dominant stricture during ERCP and direct cholangioscopy; ultrasound-guided liver biopsy; diagnostic laparoscopy with liver and lymph node biopsies). Histological examination revealed signs of IMT, and the final diagnosis of biliary IMT was stated. Although IMT is usually a benign disease, in our case, it was complicated. All pharmacological treatment measures were ineffective. The patient still needs permanent stenting, suffers from recurrent infections and mechanical jaundice. Despite that, the patient already survived 24 mo. CONCLUSION IMT presenting with hilar biliary strictures is a unique diagnostic and clinical challenge as it is indistinguishable from cholangiocarcinoma, and there are no evidence-based treatment options. Our goal is to increase the understanding of this rare disease and its possible course.
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Affiliation(s)
- Sandra Strainiene
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
| | | | - Juozas Jarasunas
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Ilona Savlan
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Juozas Stanaitis
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Ieva Stundiene
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Tomas Strainys
- Clinic of Anesthesiology and Intensive Care Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Valentina Liakina
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
- Department of Chemistry and Bioengineering, Faculty of Fundamental Science, Vilnius Gediminas Technical University, Vilnius 10223, Lithuania
| | - Jonas Valantinas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Vilnius University, Vilnius 01513, Lithuania
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27
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Abdlaty R, Abbass MA, Awadallah AM. High Precision Monitoring of Radiofrequency Ablation for Liver Using Hyperspectral Imaging. Ann Biomed Eng 2021; 49:2430-2440. [PMID: 34075450 DOI: 10.1007/s10439-021-02797-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023]
Abstract
Minimally invasive procedures are achieving better satisfaction for treating liver cancers. Energy-based techniques were studied as prospective alternatives to the gold standard of liver transplantation. Among these techniques, radiofrequency (RF) was investigated for the selective ablation of liver tissue. In addition to optimizing the RF settings for the purpose of overcoming tissue perforation or inadequate ablation, an instrument collecting quantitative data regarding the intraoperative tissue status can aid the treatment procedure. This study demonstrates an innovative noninvasive technique using hyperspectral imaging (HSI) for monitoring RF ablative therapy in ex-vivo liver tissue. The cubic data generated by HSI provides spectral as well as spatial properties of the liver tissue included in each pixel of the field of view. In our study, the applied statistical analysis saves the computational burdens of multivariate analysis techniques. For this purpose, spectral angle mapper, logistic regression algorithm, and principal component analysis were applied. Of all spectral bands captured by the HSI camera, bands centered at 760 and 960 nm were identified for predicting the ablated area. Based on statistical analysis, the threshold for predicting the ablated area of the liver samples was determined, provided that the specificity is kept at 90%.
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Affiliation(s)
- Ramy Abdlaty
- Department of Biomedical Engineering, Military Technical College, Cairo, Egypt.
| | - Mohamed A Abbass
- Department of Biomedical Engineering, Military Technical College, Cairo, Egypt
| | - Ahmed M Awadallah
- Department of Biomedical Engineering, Military Technical College, Cairo, Egypt
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28
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Chen LC, Lin HY, Hung SK, Chiou WY, Lee MS. Role of modern radiotherapy in managing patients with hepatocellular carcinoma. World J Gastroenterol 2021; 27:2434-2457. [PMID: 34092968 PMCID: PMC8160620 DOI: 10.3748/wjg.v27.i20.2434] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
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 post-monotherapy 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.
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Affiliation(s)
- Liang-Cheng Chen
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi 62247, Taiwan
| | - Hon-Yi Lin
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi 62247, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien 970, Taiwan
- Institute of Molecular Biology, National Chung Cheng University, Min-Hsiung, Chia-Yi 62102, Taiwan
| | - Shih-Kai Hung
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi 62247, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien 970, Taiwan
| | - Wen-Yen Chiou
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi 62247, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien 970, Taiwan
| | - Moon-Sing Lee
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi 62247, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien 970, Taiwan
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29
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Long Y, Liang Y, Li S, Guo J, Wang Y, Luo Y, Wu Y. Therapeutic outcome and related predictors of stereotactic body radiotherapy for small liver-confined HCC: a systematic review and meta-analysis of observational studies. Radiat Oncol 2021; 16:68. [PMID: 33832536 PMCID: PMC8034166 DOI: 10.1186/s13014-021-01761-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/11/2021] [Indexed: 12/31/2022] Open
Abstract
Background and purpose Stereotactic body radiotherapy (SBRT) is a promising ablative modality for hepatocellular carcinoma (HCC) especially for those with small-sized or early-stage tumors. This study aimed to synthesize available data to evaluate efficacy and explore related predictors of SBRT for small liver-confined HCC (≤ 3 lesions with longest diameter ≤ 6 cm). Materials and methods A systematic search were performed of the PubMed and Cochrane Library databases. Primary endpoints were overall survival (OS) and local control (LC) of small HCC treated with SBRT, meanwhile, to evaluate clinical parameters associated with treatment outcome by two methods including subgroup comparisons and pooled HR meta-analysis. The secondary endpoint was treatment toxicity. Results After a comprehensive database review, 14 observational studies with 1238 HCC patients received SBRT were included. Pooled 1-year and 3-year OS rates were 93.0% (95% confidence interval [CI] 88.0–96.0%) and 72.0% (95% CI 62.0–79.0%), respectively. Pooled 1-year and 3-year LC rates were 96.0% (95% CI 91.0–98.0%) and 91.0% (95% CI 85.0–95.0%), respectively. Subgroup comparisons regarding Child–Pugh class (stratified by CP-A percentage 100%, 75–100%, 50–75%) showed there were statistically significant differences for both 1-year and 3-year OS rate (p < 0.01), while that regarding number of lesions, pretreatment situation, age (median/mean age of 65), macrovascular invasion, tumor size, and radiation dose (median BED10 of 100 Gy), there were no differences. In subgroup comparisons for LC rate, it showed number of lesions (1 lesion vs. 2–3 lesions) was significantly associated with 1-year LC rate (p = 0.04), though not associated with 3-year LC rate (p = 0.72). In subgroup comparisons categorized by other factors including pretreatment situation, age, CP-A percentage, macrovascular invasion, tumor size, and radiation dose, there were no significant differences for 1- or 3-year LC rate. To further explore the association between CP class and OS, the second method was applied by combining HR and 95% CIs. Results indicated CP-A was predictive of better OS (p = 0.001) with pooled HR 0.31 (95% CIs 0.11–0.88), which was consistent with subgroup comparison results. Concerning adverse effect of SBRT, pooled rates of grade ≥ 3 hepatic complications and RILD were 4.0% (95% CI 2.0–8.0%) and 14.7% (95% CI 7.4–24.7%), respectively. Conclusion The study showed that SBRT was a potent local treatment for small liver-confined HCC conferring excellent OS and LC persisting up to 3 years, even though parts of included patients were pretreated or with macrovascular invasion. CP-A class was a significant predictor of optimal OS, while number of lesions might affect short term tumor control (1-year LC). Tumor size and radiation dose were not vital factors impacting treatment outcome for such small-sized HCC patients. Because of the low quality of observational studies and heterogeneous groups of patients treated with SBRT, further clinical trials should be prospectively investigated in large sample sizes. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01761-1.
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Affiliation(s)
- Yanyan Long
- Department of Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China.,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, 400030, China
| | - Yan Liang
- Division of Biological Science, University of California San Diego, San Diego, CA, 92122, USA
| | - Shujie Li
- Department of Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China
| | - Jing Guo
- Department of Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China
| | - Ying Wang
- Department of Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China.,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, 400030, China
| | - Yan Luo
- Department of Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China
| | - Yongzhong Wu
- Department of Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, China.
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30
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Sorace AG, Elkassem AA, Galgano SJ, Lapi SE, Larimer BM, Partridge SC, Quarles CC, Reeves K, Napier TS, Song PN, Yankeelov TE, Woodard S, Smith AD. Imaging for Response Assessment in Cancer Clinical Trials. Semin Nucl Med 2020; 50:488-504. [PMID: 33059819 PMCID: PMC7573201 DOI: 10.1053/j.semnuclmed.2020.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The use of biomarkers is integral to the routine management of cancer patients, including diagnosis of disease, clinical staging and response to therapeutic intervention. Advanced imaging metrics with computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) are used to assess response during new drug development and in cancer research for predictive metrics of response. Key components and challenges to identifying an appropriate imaging biomarker are selection of integral vs integrated biomarkers, choosing an appropriate endpoint and modality, and standardization of the imaging biomarkers for cooperative and multicenter trials. Imaging biomarkers lean on the original proposed quantified metrics derived from imaging such as tumor size or longest dimension, with the most commonly implemented metrics in clinical trials coming from the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, and then adapted versions such as immune-RECIST (iRECIST) and Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) for immunotherapy response and PET imaging, respectively. There have been many widely adopted biomarkers in clinical trials derived from MRI including metrics that describe cellularity and vascularity from diffusion-weighted (DW)-MRI apparent diffusion coefficient (ADC) and Dynamic Susceptibility Contrast (DSC) or dynamic contrast enhanced (DCE)-MRI (Ktrans, relative cerebral blood volume (rCBV)), respectively. Furthermore, Fluorodexoyglucose (FDG), fluorothymidine (FLT), and fluoromisonidazole (FMISO)-PET imaging, which describe molecular markers of glucose metabolism, proliferation and hypoxia have been implemented into various cancer types to assess therapeutic response to a wide variety of targeted- and chemotherapies. Recently, there have been many functional and molecular novel imaging biomarkers that are being developed that are rapidly being integrated into clinical trials (with anticipation of being implemented into clinical workflow in the future), such as artificial intelligence (AI) and machine learning computational strategies, antibody and peptide specific molecular imaging, and advanced diffusion MRI. These include prostate-specific membrane antigen (PSMA) and trastuzumab-PET, vascular tumor burden extracted from contrast-enhanced CT, diffusion kurtosis imaging, and CD8 or Granzyme B PET imaging. Further excitement surrounds theranostic procedures such as the combination of 68Ga/111In- and 177Lu-DOTATATE to use integral biomarkers to direct care and personalize therapy. However, there are many challenges in the implementation of imaging biomarkers that remains, including understand the accuracy, repeatability and reproducibility of both acquisition and analysis of these imaging biomarkers. Despite the challenges associated with the biological and technical validation of novel imaging biomarkers, a distinct roadmap has been created that is being implemented into many clinical trials to advance the development and implementation to create specific and sensitive novel imaging biomarkers of therapeutic response to continue to transform medical oncology.
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Affiliation(s)
- Anna G Sorace
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL.
| | - Asser A Elkassem
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Suzanne E Lapi
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; Department of Chemistry, University of Alabama at Birmingham, Birmingham, AL
| | - Benjamin M Larimer
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | | | - C Chad Quarles
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ
| | - Kirsten Reeves
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; Cancer Biology, University of Alabama at Birmingham, Birmingham, AL
| | - Tiara S Napier
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; Cancer Biology, University of Alabama at Birmingham, Birmingham, AL
| | - Patrick N Song
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas E Yankeelov
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX; Department of Diagnostic Medicine, University of Texas at Austin, Austin, TX; Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX
| | - Stefanie Woodard
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Andrew D Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
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31
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Eriguchi T, Tsukamoto N, Kuroiwa N, Nemoto T, Ogata T, Okubo Y, Nakano S, Sugawara A. Repeated Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma. Pract Radiat Oncol 2020; 11:44-52. [PMID: 32791232 DOI: 10.1016/j.prro.2020.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE In clinical practice, whether cirrhotic livers in patients with hepatocellular carcinoma (HCC) can withstand repeated stereotactic body radiation therapy (SBRT) remains unclear. This study aimed to evaluate the outcomes and toxicities in these patients. METHODS AND MATERIALS This retrospective study included patients with HCC who were treated with SBRT at least twice between January 2012 and June 2019. Local control and overall survival rates were calculated. Liver function before and after irradiation was evaluated using the Child-Pugh score and modified albumin-bilirubin grade. All toxicities were assessed using the Common Terminology Criteria for Adverse Events (version 4.0). RESULTS Fifty-two patients underwent 136 courses (148 lesions) of SBRT, which was mostly performed for out-of-field tumors but 3 in-field recurrences. The median follow-up duration from the first SBRT was 52.6 months (range, 15.7-89.3 months). The median gross tumor volume was 4.6 cm3 (range, 0.8-55.2 cm3) at the second SBRT. The 3-year local control rate was 94.5% (95% confidence interval, 88.0%-97.5%). The 3-year overall survival rate after the second course was 62.8% (95% confidence interval, 45.1%-76.2%). Although the Child-Pugh score did not deteriorate after the second course, deterioration of the modified albumin-bilirubin grade at 6, 12, and 24 months was statistically significant compared with that before the second course. One patient (1.9%) experienced grade 3 hypoalbuminemia and 2 patients (3.8%) had grade 3 thrombocytopenia 6 months after the second course. Mild fatigue and nausea were reported in 9 (17.3%) and 6 (11.5%) patients, respectively. One instance of grade 5 toxicity was observed. Two patients (1.5%) had grade 2 gastric ulcers. No other grade ≥3 gastrointestinal toxicities occurred. CONCLUSIONS Repeated SBRT is feasible and produces minimal toxicity in patients with HCC and Child-Pugh scores of ≤7 and a low normal liver dose.
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Affiliation(s)
- Takahisa Eriguchi
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan; Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan.
| | - Nobuhiro Tsukamoto
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Nobuko Kuroiwa
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Takafumi Nemoto
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Takeru Ogata
- Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Yusuke Okubo
- Department of Gastroenterology and Hepatology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Shigeru Nakano
- Department of Gastroenterology and Hepatology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Akitomo Sugawara
- Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Abbass MA, Ahmad SA, Mahalingam N, Krothapalli KS, Masterson JA, Rao MB, Barthe PG, Mast TD. In vivo ultrasound thermal ablation control using echo decorrelation imaging in rabbit liver and VX2 tumor. PLoS One 2019; 14:e0226001. [PMID: 31805129 PMCID: PMC6894854 DOI: 10.1371/journal.pone.0226001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/18/2019] [Indexed: 12/21/2022] Open
Abstract
The utility of echo decorrelation imaging feedback for real-time control of in vivo ultrasound thermal ablation was assessed in rabbit liver with VX2 tumor. High-intensity focused ultrasound (HIFU) and unfocused (bulk) ablation were performed using 5 MHz linear image-ablate arrays. Treatments comprised up to nine lower-power sonications, followed by up to nine higher-power sonications, ceasing when the average cumulative echo decorrelation within a control region of interest exceeded a predefined threshold (- 2.3, log10-scaled echo decorrelation per millisecond, corresponding to 90% specificity for tumor ablation prediction in previous in vivo experiments). This threshold was exceeded in all cases for both HIFU (N = 12) and bulk (N = 8) ablation. Controlled HIFU trials achieved a significantly higher average ablation rate compared to comparable ablation trials without image-based control, reported previously. Both controlled HIFU and bulk ablation trials required significantly less treatment time than these previous uncontrolled trials. Prediction of local liver and VX2 tumor ablation using echo decorrelation was tested using receiver operator characteristic curve analysis, showing prediction capability statistically equivalent to uncontrolled trials. Compared to uncontrolled trials, controlled trials resulted in smaller thermal ablation regions and higher contrast between echo decorrelation in treated vs. untreated regions. These results indicate that control using echo decorrelation imaging may reduce treatment duration and increase treatment reliability for in vivo thermal ablation.
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Affiliation(s)
- Mohamed A. Abbass
- Dept of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Syed A. Ahmad
- Dept of Surgery, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Neeraja Mahalingam
- Dept of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - K. Sameer Krothapalli
- Dept of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Jack A. Masterson
- Dept of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Marepalli B. Rao
- Dept of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, United States of America
- Dept of Environmental Health, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Peter G. Barthe
- Guided Therapy Systems/Ardent Sound, Mesa, Arizona, United States of America
| | - T. Douglas Mast
- Dept of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, United States of America
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Stereotactic body radiotherapy in patients with hepatocellular carcinoma in a multimodal treatment setting. Strahlenther Onkol 2019; 196:334-348. [DOI: 10.1007/s00066-019-01540-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/23/2019] [Indexed: 12/24/2022]
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Hardy-Abeloos C, Lazarev S, Ru M, Kim E, Fischman A, Moshier E, Rosenzweig K, Buckstein M. Safety and Efficacy of Liver Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma After Segmental Transarterial Radioembolization. Int J Radiat Oncol Biol Phys 2019; 105:968-976. [PMID: 31536781 DOI: 10.1016/j.ijrobp.2019.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE With increasing use of radiation for hepatocellular carcinoma (HCC) through transarterial radioembolization (TARE) and stereotactic body radiation therapy (SBRT), there is concern for increased radiation-related complications when using SBRT after TARE. This study compares safety of SBRT after segmental TARE versus transarterial chemoembolization (TACE). METHODS AND MATERIALS A retrospective review identified patients receiving SBRT after TACE or TARE for HCC from 2011 to 2017. TARE was delivered subselectively to individual segments using yttrium-90 with Theraspheres. Patients were assessed over time for Child-Turcott-Pugh (CTP)/albumin-bilirubin (ALBI) scores, and Common Terminology Criteria for Adverse Events version 4.0 grade ≥3 events. Linear mixed models were used to examine the trend of CTP and ALBI over time and compare groups. Secondary endpoints were objective response rate via modified Response Evaluation Criteria in Solid Tumors (RECIST), local control, and overall survival. RESULTS Ninety-nine patients met criteria with median follow-up of 9.8 months (range, 0.9-47): 31 had SBRT after segmental TARE and 68 patients post-TACE. The groups were well balanced with regard to etiology of HCC, baseline CTP and ALBI scores, and SBRT dose, but there were significant differences in baseline Eastern Cooperative Oncology Group performance status, Barcelona Clinic Liver Cancer staging, and median follow-up. There was a significant increase in post-SBRT CTP and ALBI scores (P < .0001) for both groups. However, there was no significant difference in rise in CTP (P = .11) or ALBI score (P = .82) over time between SBRT post-TACE versus post-segmental TARE. There was no significant increase in ≥grade 3 toxicity postsegmental TARE. There was also no significant difference in local controls (P = 1.0) and overall survival (P = .26) between cohorts, but objective response rate was worse post-TARE. CONCLUSIONS SBRT after segmental TARE with Theraspheres appears to have acceptable tolerability and is effective compared with SBRT after TACE. Longer follow-up with larger numbers is needed to verify these data.
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Affiliation(s)
- Camille Hardy-Abeloos
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stanislav Lazarev
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meng Ru
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edward Kim
- Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aaron Fischman
- Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin Moshier
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenneth Rosenzweig
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Park J, Park JW, Kang MK. Current status of stereotactic body radiotherapy for the treatment of hepatocellular carcinoma. Yeungnam Univ J Med 2019; 36:192-200. [PMID: 31620633 PMCID: PMC6784649 DOI: 10.12701/yujm.2019.00269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 12/19/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is an advanced form of radiotherapy (RT) with a growing interest on its application in the treatment of hepatocellular carcinoma (HCC). It can deliver ablative radiation doses to tumors in a few fractions without excessive doses to normal tissues, with the help of advanced modern RT and imaging technologies. Currently, SBRT is recommended as an alternative to curative treatments, such as surgery and radiofrequency ablation. This review discusses the current status of SBRT to aid in the decision making on how it is incorporated into the HCC management.
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Affiliation(s)
- Jongmoo Park
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae Won Park
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
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Uyei J, Taddei TH, Kaplan DE, Chapko M, Stevens ER, Braithwaite RS. Setting ambitious targets for surveillance and treatment rates among patients with hepatitis C related cirrhosis impacts the cost-effectiveness of hepatocellular cancer surveillance and substantially increases life expectancy: A modeling study. PLoS One 2019; 14:e0221614. [PMID: 31449554 PMCID: PMC6709904 DOI: 10.1371/journal.pone.0221614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatocelluar cancer (HCC) is the leading cause of death among people with hepatitis C virus (HCV)-related cirrhosis. Our aim was to determine the optimal surveillance frequency for patients with HCV-related compensated cirrhosis. METHODS We developed a decision analytic Markov model and validated it against data from the Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) study group and published epidemiologic studies. Four strategies of different surveillance intervals were compared: no surveillance and ultrasound surveillance every 12, 6, and 3 months. We estimated lifetime survival, life expectancy, quality adjusted life years (QALY), total costs associated with each strategy, and incremental cost effectiveness ratios. We applied a willingness to pay threshold of $100,000. Analysis was conducted for two scenarios: a scenario reflecting current HCV and HCC surveillance compliance rates and treatment use and an aspirational scenario. RESULTS In the current scenario the preferred strategy was 3-month surveillance with an incremental cost-effectiveness ratio (ICER) of $7,159/QALY. In the aspirational scenario, 6-month surveillance was preferred with an ICER of $82,807/QALY because treating more people with HCV led to a lower incidence of HCC. Sensitivity analyses suggested that surveillance every 12 months would suffice in the particular circumstance when patients are very likely to return regularly for testing and when appropriate HCV and HCC treatment is readily available. Compared with the current scenario, the aspirational scenario resulted in a 1.87 year gain in life expectancy for the cohort because of large reductions in decompensated cirrhosis and HCC incidence. CONCLUSIONS HCC surveillance has good value for money for patients with HCV-related compensated cirrhosis. Investments to improve adherence to surveillance should be made when rates are suboptimal. Surveillance every 12 months will suffice when patients are very likely to return regularly for testing and when appropriate HCV and HCC treatment is readily available.
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Affiliation(s)
- Jennifer Uyei
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- * E-mail:
| | - Tamar H. Taddei
- VA Connecticut-Healthcare System, West Haven, CT, United States of America
| | - David E. Kaplan
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America
| | - Michael Chapko
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, United States of America
| | - Elizabeth R. Stevens
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - R. Scott Braithwaite
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, New York, NY, United States of America
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Sayan M, Yegya-Raman N, Greco SH, Gui B, Zhang A, Chundury A, Grandhi MS, Hochster HS, Kennedy TJ, Langan RC, Malhotra U, Rustgi VK, Shah MM, Spencer KR, Carpizo DR, Nosher JL, Jabbour SK. Rethinking the Role of Radiation Therapy in the Treatment of Unresectable Hepatocellular Carcinoma: A Data Driven Treatment Algorithm for Optimizing Outcomes. Front Oncol 2019; 9:345. [PMID: 31275846 PMCID: PMC6591511 DOI: 10.3389/fonc.2019.00345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/15/2019] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the second most common cause of cancer death worldwide, with a majority of HCC patients not suitable for curative therapies. Approximately 70% of initially diagnosed patients cannot undergo surgical resection or transplantation due to locally advanced disease, poor liver function/underlying cirrhosis, or additional comorbidities. Local therapeutic options for patients with unresectable HCC, who are not suitable for thermal ablation, include transarterial embolization (bland, chemoembolization, radioembolization) and/or external beam radiation therapy (EBRT). Regarding EBRT specifically, technological advancements provide a means for safe and effective radiotherapy delivery in a wide spectrum of HCC patients. In multiple prospective studies, EBRT delivery in a variety of different fractionation schemes or in combination with transcatheter arterial chemoembolization (TACE) demonstrate improved outcomes, particularly with combination therapy. The Barcelona Clinic Liver Cancer classification provides a framework for treatment selection; however, given the growing complexity of treatment strategies, this classification system tends to simplify decision-making. In this review, we discuss the current literature regarding unresectable HCC and propose a modified treatment algorithm that emphasizes the role of radiation therapy for Child-Pugh score A or B patients with ≤3 nodules measuring >3 cm, multinodular disease or portal venous thrombosis.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Nikhil Yegya-Raman
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Stephanie H. Greco
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Bin Gui
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Andrew Zhang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Anupama Chundury
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Miral S. Grandhi
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Howard S. Hochster
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, United States
| | - Timothy J. Kennedy
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Russell C. Langan
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Usha Malhotra
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, United States
| | - Vinod K. Rustgi
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Mihir M. Shah
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Kristen R. Spencer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, United States
| | - Darren R. Carpizo
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - John L. Nosher
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Salma K. Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
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Hasanin AS, Mahmoud FM, Soliman HM. Factors affecting acid base status during hepatectomy in cirrhotic patients. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ashraf S. Hasanin
- Department of Anesthesia & ICU, National Liver Institute, Menoufia University, Egypt
| | - Fatma M.A. Mahmoud
- Department of Anesthesia & ICU, National Liver Institute, Menoufia University, Egypt
| | - Hossam M. Soliman
- Department of Hepatobiliary Surgery & Liver Transplantation, National Liver Institute, Menoufia University, Egypt
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Gerum S, Jensen AD, Roeder F. Stereotactic body radiation therapy in patients with hepatocellular carcinoma: A mini-review. World J Gastrointest Oncol 2019; 11:367-376. [PMID: 31139307 PMCID: PMC6522765 DOI: 10.4251/wjgo.v11.i5.367] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/14/2019] [Accepted: 03/27/2019] [Indexed: 02/05/2023] Open
Abstract
Stereotactic body radiation therapy (SBRT) is an emerging treatment for hepatocellular carcinoma. This technique results in excellent local control rates with favorable toxicity profile despite being predominantly used in heavily pretreated patients or those unsuitable for other local therapies. SBRT may be used as a sole treatment or in combination with other local therapies as well as a bridging strategy for patient awaiting liver transplants. This brief review describes current practice of SBRT with respect to radiation technique, patient selection and treatment concepts. It summarizes available evidence from retro- and prospective studies evaluating SBRT alone, SBRT in combination with other treatments and SBRT compared to other local treatment approaches.
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Affiliation(s)
- Sabine Gerum
- Department of Radiation Oncology, University Hospital LMU Munich, Munich, 81377, Germany
| | - Alexandra D Jensen
- Department of Radiation Oncology, University Hospital Gießen and Marburg, Marburg, 35043, Germany
| | - Falk Roeder
- CCU Molecular Radiation Oncology, German Cancer Research Center, Heidelberg, 74626, Germany
- Department of Radiotherapy and Radiation Oncology, Paracelsus Medical University, Salzburg, 5020, Austria
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Clinical feasibility and efficacy of stereotactic body radiotherapy for hepatocellular carcinoma: A systematic review and meta-analysis of observational studies. Radiother Oncol 2018; 131:135-144. [PMID: 30773180 DOI: 10.1016/j.radonc.2018.12.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/05/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Stereotactic body radiotherapy (SBRT) is an emerging ablative modality for hepatocellular carcinoma (HCC). This study aimed to synthesize available evidence to evaluate the clinical feasibility and efficacy of SBRT for HCC. MATERIALS AND METHODS A systematic search was performed of the PubMed, Medline, Embase, and Cochrane Library databases. Primary endpoints were overall survival (OS) and local control (LC), and the secondary endpoint was grade ≥3 complications. RESULTS Thirty-two studies involving 1950 HCC patients who underwent SBRT were included. Pooled 1-, 2-, and 3-year OS rates were 72.6% (95% confidence interval [CI]: 65.7-78.6), 57.8% (50.9-64.4), and 48.3% (40.3-56.5), respectively. Pooled 1-, 2-, and 3-year LC rates were 85.7% (95% CI: 80.1-90.0), 83.6% (77.4-88.3), and 83.9% (77.6-88.6), respectively. The median value of median tumor sizes among studies was 3.3 cm (range: 1.6-8.6). Median radiation doses, calculated in dose equivalent with 2 Gy per fraction, ranged from 48 to 114.8 Gy10 (median 83.3 Gy10). Subgroup comparison regarding tumor size showed significant differences for 1- and 2-year OS rates and 1-, 2-, and 3-year LC rates, and that regarding radiation dose showed no difference for OS and a marginal difference for 1-year LC rate. Pooled rates of hepatic and gastrointestinal grade ≥3 complications were 4.7% (95% CI: 3.4-6.5) and 3.9% (2.6-5.6), respectively. Child-Pugh class was significantly correlated with hepatic complication of grade ≥3 in meta-regression analysis (p = 0.013). CONCLUSION SBRT for HCC was a feasible option conferring excellent LC persisting up to 3 years. Both OS and LC were affected by tumor size, and radiation dose marginally affected LC. Severe complications rarely occurred, but liver function should be considered to avoid serious hepatic toxicity.
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Karin M. New insights into the pathogenesis and treatment of non-viral hepatocellular carcinoma: a balancing act between immunosuppression and immunosurveillance. PRECISION CLINICAL MEDICINE 2018; 1:21-28. [PMID: 30687560 PMCID: PMC6333043 DOI: 10.1093/pcmedi/pby005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/21/2018] [Accepted: 05/07/2018] [Indexed: 12/19/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths
worldwide. HCC initiates as a consequence of chronic liver damage and inflammation caused
by hepatitis B and C virus infections, excessive alcohol consumption, or non-alcoholic
fatty liver disease (NAFLD). Until recently, no effective treatments for advanced HCC were
available and the 5-year survival rate had remained below 8% for many years. New insights
into the mechanisms that drive the development of NAFLD-related HCC indicate that loss of
T-cell-mediated immunosurveillance plays a cardinal role in tumor growth and malignant
progression, in addition to previously identified inflammation-driven compensatory
proliferation. Recently completed groundbreaking clinical studies have shown that
treatments that restore antitumor immunity represent a highly effective therapeutic option
for approximately 20% of advanced HCC patients. Understanding the causes of
inflammation-driven immunosuppression and immune system dysfunction in the 80% of patients
who fail to reignite antitumor immunity despite treatment with checkpoint inhibitors
should lead to further and even more dramatic improvements in HCC immunotherapy.
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Affiliation(s)
- Michael Karin
- Laboratory of Gene Regulation and Signal Transduction, UC San Diego School of Medicine, Department of Pharmacology, 9500 Gilman Drive, La Jolla, CA, USA
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Murray LJ, Dawson LA. Advances in Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma. Semin Radiat Oncol 2017; 27:247-255. [PMID: 28577832 DOI: 10.1016/j.semradonc.2017.02.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Stereotactic Body Radiation Therapy (SBRT) is an emerging effective treatment for hepatocellular carcinoma (HCC) associated with acceptable rates of toxicity in appropriately selected patients. Despite often being reserved for patients unsuitable for other local treatments, prospective and retrospective studies have demonstrated excellent long-term control. SBRT may be used as a stand-alone treatment, or as an adjunct to other HCC therapies. Based on available data, SBRT appears to complement existing local liver therapies. Randomized and nonrandomized comparative studies are required to better determine the optimal role of SBRT in HCC treatment.
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Affiliation(s)
- Louise J Murray
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Laura A Dawson
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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Duncan JK, Ma N, Vreugdenburg TD, Cameron AL, Maddern G. Gadoxetic acid-enhanced MRI for the characterization of hepatocellular carcinoma: A systematic review and meta-analysis. J Magn Reson Imaging 2016; 45:281-290. [PMID: 27299482 DOI: 10.1002/jmri.25345] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/31/2016] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To establish the relative diagnostic accuracy of gadoxetic acid-enhanced magnetic resonance imaging (GA-MRI) compared with contrast-enhanced computed tomography (CE-CT), dynamic MRI (D-MRI), gadopentetic acid-enhanced MRI (GP-MRI), or gadobenic acid-enhanced MRI (GB-MRI) in the characterization of hepatocellular carcinoma (HCC). MATERIALS AND METHODS PubMed, EMBASE, the Cochrane Library, and the University of York CRD databases were searched to February 29 2016 for any studies that compared the diagnostic accuracy of GA-MRI to CE-CT, D-MRI, GP-MRI, or GB-MRI in patients with known or suspected HCC. Diagnostic accuracy outcomes (true positive, true negative, false positive, false negative) were extracted and analyzed using the bivariate model of Reitsma et al (2005). RESULTS In studies comparing GA-MRI to CE-CT in patients with any-sized lesions, estimated sensitivities were 0.881 (95% confidence interval [CI] = 0.766, 0.944) and 0.713 (95% CI = 0.577, 0.819) respectively. Estimated specificities were 0.926 (95% CI = 0.829, 0.97) and 0.918 (95% CI = 0.829, 0.963), respectively. This difference was not statistically significant. In studies including patients with small lesions GA-MRI was superior to CE-CT, with estimated sensitivities of 0.919 (95% CI = 0.834, 0.962) and 0.637 (95% CI = 0.565, 0.704 and estimated specificities of 0.936 (95% CI = 0.882, 0.966) and 0.971 (95% CI = 0.937, 0.987), respectively. In studies comparing GA-MRI to D-MRI in patients with any-sized lesions estimated sensitivities were 0.907 (95% CI = 0.870, 0.934) and 0.820 (95% CI = 0.776, 0.857); estimated specificities were 0.929 (95% CI = 0.877, 0.961) and 0.934 (95% CI = 0.881, 0.964). CONCLUSION GA-MRI has superior diagnostic ability to CE-CT in patients with small lesions. In patients with any-sized lesions there is no evidence that GA-MRI is superior to either CE-CT to D-MRI. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:281-290.
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Affiliation(s)
- Joanna K Duncan
- Australian Safety and Efficacy Register of New Interventional Procedures, Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Ning Ma
- Australian Safety and Efficacy Register of New Interventional Procedures, Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Thomas D Vreugdenburg
- Australian Safety and Efficacy Register of New Interventional Procedures, Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Alun L Cameron
- Australian Safety and Efficacy Register of New Interventional Procedures, Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Guy Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures, Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, University of Adelaide and the Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Somasundaram VH, Pillai R, Malarvizhi G, Ashokan A, Gowd S, Peethambaran R, Palaniswamy S, Unni AKK, Nair S, Koyakutty M. Biodegradable Radiofrequency Responsive Nanoparticles for Augmented Thermal Ablation Combined with Triggered Drug Release in Liver Tumors. ACS Biomater Sci Eng 2016; 2:768-779. [DOI: 10.1021/acsbiomaterials.5b00511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Vijay Harish Somasundaram
- Amrita Center for Nanosciences & Molecular Medicine, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara P.O. Kochi, Kerala 682041, India
| | - Rashmi Pillai
- Amrita Center for Nanosciences & Molecular Medicine, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara P.O. Kochi, Kerala 682041, India
| | - Giridharan Malarvizhi
- Amrita Center for Nanosciences & Molecular Medicine, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara P.O. Kochi, Kerala 682041, India
| | - Anusha Ashokan
- Amrita Center for Nanosciences & Molecular Medicine, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara P.O. Kochi, Kerala 682041, India
| | - Siddaramana Gowd
- Amrita Center for Nanosciences & Molecular Medicine, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara P.O. Kochi, Kerala 682041, India
| | - Reshmi Peethambaran
- Amrita Center for Nanosciences & Molecular Medicine, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara P.O. Kochi, Kerala 682041, India
| | - Shanmugasundaram Palaniswamy
- Amrita Center for Nanosciences & Molecular Medicine, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara P.O. Kochi, Kerala 682041, India
| | - AKK Unni
- Amrita Center for Nanosciences & Molecular Medicine, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara P.O. Kochi, Kerala 682041, India
| | - Shantikumar Nair
- Amrita Center for Nanosciences & Molecular Medicine, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara P.O. Kochi, Kerala 682041, India
| | - Manzoor Koyakutty
- Amrita Center for Nanosciences & Molecular Medicine, Amrita Institute of Medical Science & Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara P.O. Kochi, Kerala 682041, India
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Rathke H, Hamm B, Güttler F, Rathke J, Rump J, Teichgräber U, de Bucourt M. Comparison of four radiofrequency ablation systems at two target volumes in an ex vivo bovine liver model. Diagn Interv Radiol 2015; 20:251-8. [PMID: 24509185 DOI: 10.5152/dir.2013.13157] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to validate actually achieved macroscopic ablation volumes in relation to calculated target volumes using four different radiofrequency ablation (RFA) systems operated with default settings and protocols for 3 cm and 5 cm target volumes in ex vivo bovine liver. MATERIALS AND METHODS Sixty-four cuboid liver specimens were ablated with four commercially available RFA systems (Radionics Cool-tip, AngioDynamic 1500X, Boston Scientific RF 3000, Celon CelonPower LAB): 16 specimens for each system; eight for 3 cm, and eight for 5 cm. Ablation diameters were measured, volumes were calculated, and RFA times were recorded. RESULTS For the 3 cm target ablation volume, all tested RFA systems exceeded the mathematically calculated volume of 14.14 cm3. For the 3 cm target ablation volume, mean ablation volume and mean ablation time for each RFA system were as follows: 28.5 ± 6.5 cm3, 12.0 ± 0.0 min for Radionics Cool-tip; 17.1 ± 4.9 cm3, 9.36 ± 0.63 min for AngioDynamic 1500X; 29.7 ± 11.7 cm3, 4.60 ± 0.50 min for Boston Scientific RF 3000; and 28.8 ± 7.0 cm3, 20.85 ± 0.86 min for Celon CelonPower LAB. For the 5 cm target ablation volume, Radionics Cool-tip (48.3 ± 9.9 cm3, 12.0 ± 0.0 min) and AngioDynamic 1500X (39.4 ± 16.2 cm3, 19.59 ± 1.13 min) did not reach the mathematically calculated target ablation volume (65.45 cm3), whereas Boston Scientific RF 3000 (71.8 ± 14.5 cm3, 9.15 ± 2.93 min) and Celon CelonPower LAB (93.9 ± 28.1 cm3, 40.21 ± 1.78 min) exceeded it. CONCLUSION While all systems reached the 3 cm target ablation volume, results were variable for the 5 cm target ablation volume. Only Boston Scientific RF 3000 and Celon CelonPower LAB created volumes above the target, whereas Radionics Cool-tip and AngioDynamic 1500X remained below the target volume. For the 3 cm target ablation volume, AngioDynamic 1500X with 21% deviation was closest to the target volume. For the 5 cm target volume Boston Scientific RF 3000 with 10% deviation was closest.
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Affiliation(s)
- Hendrik Rathke
- From the Department of Radiology University of Natural Resources and Life Sciences, Vienna, Austria.
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Rathke H, Hamm B, Guettler F, Lohneis P, Stroux A, Suttmeyer B, Jonczyk M, Teichgräber U, de Bucourt M. Volume comparison of radiofrequency ablation at 3- and 5-cm target volumes for four different radiofrequency generators: MR volumetry in an open 1-T MRI system versus macroscopic measurement. ACTA ACUST UNITED AC 2015; 60:521-31. [PMID: 26057213 DOI: 10.1515/bmt-2014-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/07/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In a patient, it is usually not macroscopically possible to estimate the non-viable volume induced by radiofrequency ablation (RFA) after the procedure. The purpose of this study was to use an ex vivo bovine liver model to perform magnetic resonance (MR) volumetry of the visible tissue signal change induced by RFA and to correlate the MR measurement with the actual macroscopic volume measured in the dissected specimens. MATERIALS AND METHODS Sixty-four liver specimens cut from 16 bovine livers were ablated under constant simulated, close physiological conditions with target volumes set to 14.14 ml (3-cm lesion) and 65.45 ml (5-cm lesion). Four commercially available radiofrequency (RF) systems were tested (n=16 for each system; n=8 for 3 cm and n=8 for 5 cm). A T1-weighted turbo spin echo (TSE) sequence with inversion recovery and a proton-density (PD)-weighted TSE sequence were acquired in a 1.0-T open magnetic resonance imaging (MRI) system. After manual dissection, actual macroscopic ablation diameters were measured and volumes calculated. MR volumetry was performed using a semiautomatic software tool. To validate the correctness and feasibility of the volume formula in macroscopic measurements, MR multiplanar reformation diameter measurements with subsequent volume calculation and semiautomatic MR volumes were correlated. RESULTS Semiautomatic MR volumetry yielded smaller volumes than manual measurement after dissection, irrespective of RF system used, target lesion size, and MR sequence. For the 3-cm lesion, only 43.3% (T1) and 41.5% (PD) of the entire necrosis are detectable. For the 5-cm lesion, only 40.8% (T1) and 37.2% (PD) are visualized in MRI directly after intervention. The correlation between semiautomatic MR volumes and calculated MR volumes was 0.888 for the T1-weighted sequence and 0.875 for the PD sequence. CONCLUSION After correlation of semiautomatic MR volumes and calculated MR volumes, it seems reasonable to use the respective volume formula for macroscopic volume calculation. Hyperacute MRI after ex vivo intervention may result in the underestimation of the real expansion of the produced necrosis zone. This must be kept in mind when using MRI for validating ablation success directly after RFA. One reason for the discrepancy between macroscopic and MRI appearance immediately after RFA may be that the transitional zone shows no or only partially visible MR signal change.
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Kim YC, Kim MJ, Park YN, Kim KS, Ahn SH, Jung SE, Kim JK. Relationship between severity of liver dysfunction and the relative ratio of liver to aortic enhancement (RE) on MRI using hepatocyte-specific contrast. J Magn Reson Imaging 2013; 39:24-30. [PMID: 23553935 DOI: 10.1002/jmri.24100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 02/06/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate differences in liver enhancement among patients with low and high morbidity risks and to determine the relationship between severity of liver dysfunction and the relative ratio of liver to aortic enhancement (RE) on MRI using hepatocyte-specific contrast. MATERIALS AND METHODS A total of 126 patients underwent magnetic resonance imaging (MRI) and blood serum testing including serology, bilirubin, international normalized ratio, and creatinine tests. Radiologists analyzed a region of interest in the liver and aorta on precontrast and 10- and 20-minute delayed hepatobiliary phase MR images. Liver enhancement after 10 (LE10min ) and 20 minutes (LE20min ) were compared between the low- and high-risk groups by independent t-test. Regression analysis was used to assess the relationship between the Model for Endstage Liver Disease (MELD) score and RE. RESULTS All 126 patients were classified into either the low-risk group (MELD <8; n = 85) or high-risk group (MELD ≥8; n = 41). The mean LE10min and LE20min were significantly higher in the low-risk group (471.61; 95% confidence interval [CI]: 449.79-493.43 and 510.69; 95% CI: 486.51-534.87, respectively) than in the high-risk group (401.6776; 95% CI: 364.75-438.61 and 413.81; 95% CI: 370.91-456.70). There was a moderate inverse correlation between MELD score and the relative ratio of liver enhancement (RLE) (r = -0.5442; 95% CI: -0.6480 to -0.4207; P<0.01), but a high positive correlation between MELD score and RE (r = 0.7470; 95% CI: 0.6665-0.8102; P < 0.01). CONCLUSION Although liver enhancement was significantly greater in low-risk patients compared to high-risk patients, RE may be a better predictor of liver function than RLE.
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Affiliation(s)
- Young Chul Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Republic of Korea
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Integrating Radioembolization (90Y Microspheres) Into Current Treatment Options for Liver Tumors. Am J Clin Oncol 2012; 35:81-90. [DOI: 10.1097/coc.0b013e3181ec60b8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
Locoregional therapies for hepatocellular carcinoma have progressed greatly in the last 30 years, beginning with the introduction of chemoembolization. Embolization techniques have evolved with the use of drug-eluting beads and radioembolization with yttrium-90. In the last 10 years, several new ablation techniques were developed including radiofrequency ablation, microwave ablation, cryoablation, laser ablation, and irreversible electroporation. Isolated or in combination, these techniques have already shown that they can improve patient survival and/or provide acceptable palliation.
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Affiliation(s)
- Marcelo Guimaraes
- Division of Vascular & Interventional Radiology, Medical University of South Carolina, 25 Courtenay Drive, MSC 226, Charleston, SC 29425, USA.
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