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High-dose stereotactic body radiotherapy correlates increased local control and overall survival in patients with inoperable hepatocellular carcinoma.

Jang WI, Kim MS, Bae SH, Cho CK, Yoo HJ, Seo YS, Kang JK, Kim SY, Lee DH, Han CJ, Kim J, Park SC, Kim SB, Cho EH, Kim YH - Radiat Oncol (2013)

Bottom Line: The median LD was 3.0 cm (range, 1.0-7.0 cm), and the median dose was 51 Gy (range, 33-60 Gy).The 2-year LC/OS rates for patients treated with doses of > 54, 45-54, and < 45 Gy were 100/71, 78/64, and 64%/30%, respectively (p = .009/p < .001).Higher LC rates resulting from an increased dose may translate into survival benefits for patients with HCC.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Science, Seoul, Republic of Korea. mskim@kirams.re.kr.

ABSTRACT

Background: Recent studies using stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) have reported high tumor response and local control. However, the optimal SBRT dose remains unknown, and it is still not clear whether a dose response relationship for local control (LC) and overall survival (OS) exist or not. We performed this study to determine whether a dose response relationship for LC and OS is observed in SBRT for inoperable HCC.

Methods: Between 2003 and 2011, 108 patients with HCC were treated with SBRT. All patients were unsuitable for surgery or local ablation and had incomplete response to transarterial chemoembolization. Eighty-two patients with a longest tumor diameter (LD) less than or equal to 7.0 cm who were treated with 3-fraction SBRT and were analyzed. This cohort comprised 74 Child-Turcotte-Pugh (CTP) class A patients and 8 CTP class B7 patients. The median LD was 3.0 cm (range, 1.0-7.0 cm), and the median dose was 51 Gy (range, 33-60 Gy).

Results: LC and OS rates at 2 years after SBRT were 87% and 63%, respectively, with a median follow-up duration of 30 months for all patients. The 2-year LC/OS rates for patients treated with doses of > 54, 45-54, and < 45 Gy were 100/71, 78/64, and 64%/30%, respectively (p = .009/p < .001). Multivariate analysis revealed that the SBRT dose (p = .005) and Barcelona Clinic Liver Cancer stage (p = .015) were significant prognostic factors for OS. Correlation analysis revealed a positive linear relationship between the SBRT dose and LC (p = .006, R = .899)/OS (p = .002, R = .940) at 2 years. Based on the tumor-control probability model, a dose of 54.8 Gy provides 2-year LC with a 90% probability. Five patients experienced grade 3 or higher gastrointestinal toxicity, and 6 had deteriorating of CTP score by greater than or equal to 2 within 3 months of SBRT.

Conclusions: This study demonstrated a dose response relationship for LC and OS with SBRT for HCC. Higher LC rates resulting from an increased dose may translate into survival benefits for patients with HCC.

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Related in: MedlinePlus

Tumor control probability (TCP) curve by the 3-fraction stereotactic body radiotherapy (SBRT) dose. (a) All lesions (n = 95); (b) 1.0 cm ≤ Longest diameter (LD) ≤ 5.0 cm (n = 83); (c) 5.0 cm < LD ≤ 7.0 cm (n = 12). CI, confidence interval.
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Figure 4: Tumor control probability (TCP) curve by the 3-fraction stereotactic body radiotherapy (SBRT) dose. (a) All lesions (n = 95); (b) 1.0 cm ≤ Longest diameter (LD) ≤ 5.0 cm (n = 83); (c) 5.0 cm < LD ≤ 7.0 cm (n = 12). CI, confidence interval.

Mentions: Figure 4(a) shows the fitted TCP of the SBRT dose versus the 2-year LC for all 95 lesions as plotted by the following fitted parameters: γ50 = 1.22 and TCD50 = 34.9 (95% CI, 32.6-37.2). According to the TCP curve, doses of 54.8 Gy (95% CI, 51.2-58.4) and 46.4 Gy (95% CI, 43.3-49.5) provide 2-year LC with probabilities of 90% and 80%, respectively. Figures 4(b) and 4(c) show the fitted TCP of the SBRT dose versus the 2-year LC for 83 lesions with LD ≤ 5.0 cm and 12 lesions with LD > 5.0 cm, respectively.


High-dose stereotactic body radiotherapy correlates increased local control and overall survival in patients with inoperable hepatocellular carcinoma.

Jang WI, Kim MS, Bae SH, Cho CK, Yoo HJ, Seo YS, Kang JK, Kim SY, Lee DH, Han CJ, Kim J, Park SC, Kim SB, Cho EH, Kim YH - Radiat Oncol (2013)

Tumor control probability (TCP) curve by the 3-fraction stereotactic body radiotherapy (SBRT) dose. (a) All lesions (n = 95); (b) 1.0 cm ≤ Longest diameter (LD) ≤ 5.0 cm (n = 83); (c) 5.0 cm < LD ≤ 7.0 cm (n = 12). CI, confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231524&req=5

Figure 4: Tumor control probability (TCP) curve by the 3-fraction stereotactic body radiotherapy (SBRT) dose. (a) All lesions (n = 95); (b) 1.0 cm ≤ Longest diameter (LD) ≤ 5.0 cm (n = 83); (c) 5.0 cm < LD ≤ 7.0 cm (n = 12). CI, confidence interval.
Mentions: Figure 4(a) shows the fitted TCP of the SBRT dose versus the 2-year LC for all 95 lesions as plotted by the following fitted parameters: γ50 = 1.22 and TCD50 = 34.9 (95% CI, 32.6-37.2). According to the TCP curve, doses of 54.8 Gy (95% CI, 51.2-58.4) and 46.4 Gy (95% CI, 43.3-49.5) provide 2-year LC with probabilities of 90% and 80%, respectively. Figures 4(b) and 4(c) show the fitted TCP of the SBRT dose versus the 2-year LC for 83 lesions with LD ≤ 5.0 cm and 12 lesions with LD > 5.0 cm, respectively.

Bottom Line: The median LD was 3.0 cm (range, 1.0-7.0 cm), and the median dose was 51 Gy (range, 33-60 Gy).The 2-year LC/OS rates for patients treated with doses of > 54, 45-54, and < 45 Gy were 100/71, 78/64, and 64%/30%, respectively (p = .009/p < .001).Higher LC rates resulting from an increased dose may translate into survival benefits for patients with HCC.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Korea Institute of Radiological & Medical Science, Seoul, Republic of Korea. mskim@kirams.re.kr.

ABSTRACT

Background: Recent studies using stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) have reported high tumor response and local control. However, the optimal SBRT dose remains unknown, and it is still not clear whether a dose response relationship for local control (LC) and overall survival (OS) exist or not. We performed this study to determine whether a dose response relationship for LC and OS is observed in SBRT for inoperable HCC.

Methods: Between 2003 and 2011, 108 patients with HCC were treated with SBRT. All patients were unsuitable for surgery or local ablation and had incomplete response to transarterial chemoembolization. Eighty-two patients with a longest tumor diameter (LD) less than or equal to 7.0 cm who were treated with 3-fraction SBRT and were analyzed. This cohort comprised 74 Child-Turcotte-Pugh (CTP) class A patients and 8 CTP class B7 patients. The median LD was 3.0 cm (range, 1.0-7.0 cm), and the median dose was 51 Gy (range, 33-60 Gy).

Results: LC and OS rates at 2 years after SBRT were 87% and 63%, respectively, with a median follow-up duration of 30 months for all patients. The 2-year LC/OS rates for patients treated with doses of > 54, 45-54, and < 45 Gy were 100/71, 78/64, and 64%/30%, respectively (p = .009/p < .001). Multivariate analysis revealed that the SBRT dose (p = .005) and Barcelona Clinic Liver Cancer stage (p = .015) were significant prognostic factors for OS. Correlation analysis revealed a positive linear relationship between the SBRT dose and LC (p = .006, R = .899)/OS (p = .002, R = .940) at 2 years. Based on the tumor-control probability model, a dose of 54.8 Gy provides 2-year LC with a 90% probability. Five patients experienced grade 3 or higher gastrointestinal toxicity, and 6 had deteriorating of CTP score by greater than or equal to 2 within 3 months of SBRT.

Conclusions: This study demonstrated a dose response relationship for LC and OS with SBRT for HCC. Higher LC rates resulting from an increased dose may translate into survival benefits for patients with HCC.

Show MeSH
Related in: MedlinePlus