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• W2168390983 abstract "Purpose/Objective(s)Partial hepatectomy or liver transplantation is the preferred treatment for managing hepatocellular carcinoma (HCC). However, there is no standard non-surgical therapy to manage patients who have unresectable disease. In addition, there is no standard management option to keep tumors within acceptable listing criteria, while patients wait for planned transplantation. We evaluated the efficacy of treating HCC with transarterial chemoembolization (TACE) followed by stereotactic radiosurgery (SRS) for patients with unresectable disease, borderline functional status/poor surgical candidates, or for those awaiting transplantation.Materials/MethodsPatients with HCC staged as T1-T3N0M0 (n = 18) or metastatic disease from HCC or other primary (n = 3) were referred for SRS. A total of 21 patients with 37 lesions were treated. Each patient had 1-4 lesions (diameter range 1.4 - 8.1 cm) and 86% of the patients received TACE prior to SRS. Five patients qualified for transplant therapy prior to TACE+SRS. Respiratory and target motion was accounted for during multimodality (4DCT, MRI, US) simulation imaging, treatment planning, image guided target localization, and respiratory gated treatment delivery. A total of 1 to 3 fractions (fx) were used to deliver a dose ranging from 14 - 45 Gy, over a period of up to 2 weeks. The most common prescription was 36 Gy in 3 fx (n = 8), followed by 45 Gy in 3 fx (n = 4).ResultsAll 5 patients previously considered for transplant therapy remained qualified to complete their procedure (i.e., none progressed outside of permissible criteria). Upon explant evaluation, 60% of the transplanted patients (n = 3) had no residual viable tumor. None of the 21 patients experienced greater than grade 2 toxicity from treatment and median survival was 22.9 months (25-75th percentile: 11.8 - 39.9 months). Kaplan-Meier estimates further revealed 12 and 18 month survival at 73.9% and 62.9%, respectively. When averaged for 21 patients, the volume of the treated PTVs was 38.3 cm3 (range 5.9 - 342 cm3), the mean liver dose was 877 cGy (range 133-1,542 cGy), and the dose to 70% of the liver (D70) was 352 cGy (range 9-1010 cGy). Univariate Cox proportional hazard regression found that survival was significantly associated with age at diagnosis (p = 0.043) and pretreatment serum alpha-fetoprotein (p = 0.015). However, neither age at diagnosis (p = 0.351) nor pretreatment alpha-fetoprotein (p = 0.077) reached significance in multivariate analysis.ConclusionsThis review suggests that TACE followed by SRS is an effective and safe treatment option for patients with HCC who are not readily able to undergo hepatic resection or transplantation. Studies using a larger number of patients with pre-defined criteria need to be done to assess its utility. Purpose/Objective(s)Partial hepatectomy or liver transplantation is the preferred treatment for managing hepatocellular carcinoma (HCC). However, there is no standard non-surgical therapy to manage patients who have unresectable disease. In addition, there is no standard management option to keep tumors within acceptable listing criteria, while patients wait for planned transplantation. We evaluated the efficacy of treating HCC with transarterial chemoembolization (TACE) followed by stereotactic radiosurgery (SRS) for patients with unresectable disease, borderline functional status/poor surgical candidates, or for those awaiting transplantation. Partial hepatectomy or liver transplantation is the preferred treatment for managing hepatocellular carcinoma (HCC). However, there is no standard non-surgical therapy to manage patients who have unresectable disease. In addition, there is no standard management option to keep tumors within acceptable listing criteria, while patients wait for planned transplantation. We evaluated the efficacy of treating HCC with transarterial chemoembolization (TACE) followed by stereotactic radiosurgery (SRS) for patients with unresectable disease, borderline functional status/poor surgical candidates, or for those awaiting transplantation. Materials/MethodsPatients with HCC staged as T1-T3N0M0 (n = 18) or metastatic disease from HCC or other primary (n = 3) were referred for SRS. A total of 21 patients with 37 lesions were treated. Each patient had 1-4 lesions (diameter range 1.4 - 8.1 cm) and 86% of the patients received TACE prior to SRS. Five patients qualified for transplant therapy prior to TACE+SRS. Respiratory and target motion was accounted for during multimodality (4DCT, MRI, US) simulation imaging, treatment planning, image guided target localization, and respiratory gated treatment delivery. A total of 1 to 3 fractions (fx) were used to deliver a dose ranging from 14 - 45 Gy, over a period of up to 2 weeks. The most common prescription was 36 Gy in 3 fx (n = 8), followed by 45 Gy in 3 fx (n = 4). Patients with HCC staged as T1-T3N0M0 (n = 18) or metastatic disease from HCC or other primary (n = 3) were referred for SRS. A total of 21 patients with 37 lesions were treated. Each patient had 1-4 lesions (diameter range 1.4 - 8.1 cm) and 86% of the patients received TACE prior to SRS. Five patients qualified for transplant therapy prior to TACE+SRS. Respiratory and target motion was accounted for during multimodality (4DCT, MRI, US) simulation imaging, treatment planning, image guided target localization, and respiratory gated treatment delivery. A total of 1 to 3 fractions (fx) were used to deliver a dose ranging from 14 - 45 Gy, over a period of up to 2 weeks. The most common prescription was 36 Gy in 3 fx (n = 8), followed by 45 Gy in 3 fx (n = 4). ResultsAll 5 patients previously considered for transplant therapy remained qualified to complete their procedure (i.e., none progressed outside of permissible criteria). Upon explant evaluation, 60% of the transplanted patients (n = 3) had no residual viable tumor. None of the 21 patients experienced greater than grade 2 toxicity from treatment and median survival was 22.9 months (25-75th percentile: 11.8 - 39.9 months). Kaplan-Meier estimates further revealed 12 and 18 month survival at 73.9% and 62.9%, respectively. When averaged for 21 patients, the volume of the treated PTVs was 38.3 cm3 (range 5.9 - 342 cm3), the mean liver dose was 877 cGy (range 133-1,542 cGy), and the dose to 70% of the liver (D70) was 352 cGy (range 9-1010 cGy). Univariate Cox proportional hazard regression found that survival was significantly associated with age at diagnosis (p = 0.043) and pretreatment serum alpha-fetoprotein (p = 0.015). However, neither age at diagnosis (p = 0.351) nor pretreatment alpha-fetoprotein (p = 0.077) reached significance in multivariate analysis. All 5 patients previously considered for transplant therapy remained qualified to complete their procedure (i.e., none progressed outside of permissible criteria). Upon explant evaluation, 60% of the transplanted patients (n = 3) had no residual viable tumor. None of the 21 patients experienced greater than grade 2 toxicity from treatment and median survival was 22.9 months (25-75th percentile: 11.8 - 39.9 months). Kaplan-Meier estimates further revealed 12 and 18 month survival at 73.9% and 62.9%, respectively. When averaged for 21 patients, the volume of the treated PTVs was 38.3 cm3 (range 5.9 - 342 cm3), the mean liver dose was 877 cGy (range 133-1,542 cGy), and the dose to 70% of the liver (D70) was 352 cGy (range 9-1010 cGy). Univariate Cox proportional hazard regression found that survival was significantly associated with age at diagnosis (p = 0.043) and pretreatment serum alpha-fetoprotein (p = 0.015). However, neither age at diagnosis (p = 0.351) nor pretreatment alpha-fetoprotein (p = 0.077) reached significance in multivariate analysis. ConclusionsThis review suggests that TACE followed by SRS is an effective and safe treatment option for patients with HCC who are not readily able to undergo hepatic resection or transplantation. Studies using a larger number of patients with pre-defined criteria need to be done to assess its utility. This review suggests that TACE followed by SRS is an effective and safe treatment option for patients with HCC who are not readily able to undergo hepatic resection or transplantation. Studies using a larger number of patients with pre-defined criteria need to be done to assess its utility." @default.
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• W2168390983 date "2010-11-01" @default.
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• W2168390983 title "Effective Treatment of Hepatocellular Carcinoma with Stereotactic Radiosurgery Combined with Chemo-embolization" @default.
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