Stereotactic Body Radiotherapy: Does It Have a Role in Management of Hepatocellular Carcinoma?

최서희,성진실 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.8

Stereotactic body radiotherapy (SBRT) is a form of radiotherapy that delivers high doses of irradiation with high precision in a small number of fractions. However, it has not frequently been performed for the liver due to the risk of radiation-induced liver toxicity. Furthermore, liver SBRT is cumbersome because it requires accurate patient repositioning, target localization, control of breathing-related motion, and confers a toxicity risk to the small bowel. Recently, with the advancement of modern technologies including intensity-modulated RT and image-guided RT, SBRT has been shown to significantly improve local control and survival outcomes for hepatocellular carcinoma (HCC), specifically those unfit for other local therapies. While it can be used as a stand-alone treatment for those patients, it can also be applied either as an alternative or as an adjunct to other HCC therapies (e.g., transarterial chemoembolization, and radiofrequency ablation). SBRT might be an effective and safe bridging therapy for patientsawaiting liver transplantation. Furthermore, in recent studies, SBRT has been shown to have a potential role as an immunostimulator,supporting the novel combination strategy of immunoradiotherapy for HCC. In this review, the role of SBRT with some technical issues is discussed. In addition, future implications of SBRT as an immunostimulator are considered.

Current status of stereotactic body radiotherapy for the treatment of hepatocellular carcinoma

Jongmoo Park,박재원,강민규 영남대학교 의과대학 2019 Yeungnam University Journal of Medicine Vol.36 No.3

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.

Stereotactic Body Radiotherapy for Early Stage Lung Cancer

Yasushi Nagata 대한암학회 2013 Cancer Research and Treatment Vol.45 No.3

Stereotactic body radiation therapy (SBRT) is a newly developed technique currently in clinical use. SBRT originated from stereotactic radiosurgery for intracranial tumors. SBRT has been widely used clinically for lung cancer. The practice of SBRT demands different kinds of patient fixation, breathing control, target determination, treatment planning, and verifications. The history and current standard technique are reviewed. Clinical studies of lung cancer showed high local control rates with acceptable toxicities. Past and on-going clinical trials are reviewed.

Current status of stereotactic body radiotherapy for the treatment of hepatocellular carcinoma

Park, Jongmoo,Park, Jae Won,Kang, Min Kyu Yeungnam University College of Medicine 2019 Yeungnam University Journal of Medicine Vol.36 No.3

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.

Bone-only oligometastatic prostate cancer: can SABR improve outcomes? A single-center experience

Angel L. Sanchez-Iglesias 대한방사선종양학회 2022 Radiation Oncology Journal Vol.40 No.3

Ablative treatment of oligometastases has shown survival benefit with certain tumors, al-though these effects still are to be demonstrated in prostate cancer. Materials and Methods: We analysed the toxicity and clinical control results obtained in patients withbone-only oligometastatic prostate cancer treated with stereotactic ablative radiotherapy (SABR). Ret-rospective study on patients with metachronous oligoprogression and synchronous de novo bone-onlyoligometastatic prostate cancer treated with SABR and androgen deprivation therapy. Results: Treatment schedules varied according to location and organs at risk, with biologically equiv-alent dose (BED) ≥100 Gy. Fifty-five bone lesions (31 patients) were treated and evaluated for toxicity,local control, progression-free survival (PFS), and overall survival (OS). After a 41-month follow-up,there was minimal acute or chronic toxicity and no G3 toxicity. The local control at 3 and 5 years was100% and 87.1%, respectively. Median PFS and OS were 43 and 98 months, respectively. The best re-sult in PFS was obtained with BED ≥230 Gy, delaying time to the next systemic therapy by 28.5months. Conclusion: The use of SABR in bone oligometastases of prostate cancer is safe with minimal toxicityand excellent results in local control and PFS, delaying the start of the next systemic therapy. Keywords: Stereotactic body radiotherapy, Bone oligometastases, Prostate cancer, Next systemictherapy

Endoscopic Ultrasound–Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Pancreatic Malignancy

Seong-Hun Kim,Eun Ji Shin 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.3

Stereotactic body radiation therapy (SBRT) is an important treatment option for pancreatic cancer, which is known to be one of themalignancies with the worst prognosis. However, the high radiation doses delivered during SBRT may cause damage to adjacentradiosensitive organs. To minimize such damage, fiducial markers are used for localization during SBRT for pancreatic cancer. Thedevelopment of endoscopic ultrasound (EUS) has enabled fiducial markers to be inserted into the pancreas using an EUS fine-needleaspiration (FNA) needle, unlike in the past when percutaneous placement was generally performed. For successful EUS-guidedfiducial marker placement, it is necessary for the fiducial markers to be loaded within the EUS-FNA needles to have a low probabilityof complications and a low migration risk, and to be stably observed in SBRT imaging. A systematic review has shown that thetechnical success rate of EUS-guided fiducial marker placement is 96.27%, whereas the fiducial marker migration and adverse eventrates are 4.33% and 4.85%, respectively. Nonetheless, standardized techniques for fiducial marker placement and the characteristicsof optimal fiducial markers have not yet been established. This review will introduce the characteristics (e.g., materials and shapes) offiducial markers used in fiducial marker placement for pancreatic cancer and will discuss conventional techniques along with theirsuccess rates, difficulties, and adverse events.

Stereotactic body radiation therapy for elderly patients with small hepa- tocellular carcinoma: a retrospective observational study

Jeong Yun Jang,정진홍,이단비,심주현,김강모,임영석,이한주,박진홍,윤상민 대한간암학회 2022 대한간암학회지 Vol.22 No.2

Background/Aim: We aimed to investigate the efficacy and safety of stereotactic body radiation therapy (SBRT) in elderly patients with small hepatocellular carcinomas (HCC). Methods: Eighty-three patients (89 lesions) with HCC who underwent SBRT between January 2012 and December 2018 were reviewed in this retrospective observational study. The key inclusion criteria were as follows: 1) age ≥75 years, 2) contraindications for hepatic resection or percutaneous ablative therapies, 3) no macroscopic vascular invasion, and 4) no extrahepatic metastasis. Results: The patients were 75-90 years of age, and 49 (59.0%) of them were male. Most patients (94.0%) had an Eastern Cooperative Oncology Group performance status of 0 or1. Seventy-four patients (89.2%) had Child-Pugh class A hepatic function before SBRT. The median tumor size was 1.6 cm (range, 0.7-3.5). The overall median follow-up period was34.8 months (range, 7.3-99.3). The 5-year local tumor control rate was 90.1%. The 3-year and 5-year overall survival rate was 57.1% and 40.7%, respectively. Acute toxicity grade ≥3 was observed in three patients (3.6%) with elevated serum hepatic enzymes; however, no patient experienced a worsening of the Child-Pugh score to ≥2 after SBRT. None of the patients developed late toxicity (grade ≥3). Conclusions: SBRT is a safe treatment option with a high local control rate in elderly patients with small HCC who are not eligible for other curative treatments.

Analysis of Biologically Equivalent Dose of Stereotactic Body Radiotherapy for Primary and Metastatic Lung Tumors

박성광,엄상화,조흥래 대한암학회 2014 Cancer Research and Treatment Vol.46 No.4

PurposeThe purpose of this study was to determine the optimal biologically equivalent dose (BED)for stereotactic body radiotherapy (SBRT) by comparing local control rates in proportion tovarious total doses and fractionation schedules. Materials and MethodsThirty-four patients with early non-small-cell lung cancer and a single metastatic lung tumorwere included in this study. Differences in local control rates were evaluated according togender, primary tumor site, response, tumor size, and BED. For comparison of BEDs, theprescribed dose for SBRT was stratified according to three groups: high (BED > 146 Gy),medium to high (BED, 106 to 146 Gy), and low to medium (BED < 106 Gy). ResultsFor all patients, the overall local control rate was 85.3% at two years after treatment. Fivelocal recurrences were observed, and, notably, all of them were observed in the low tomedium BED group. Significantly higher local control rates were observed for patients witha complete response than for those with a partial response or stable disease (p < 0.001). Twenty-six patients with a tumor size of < 3 cm showed no dose-response relationship inthe low to medium, medium to high, and high BED groups, whereas eight patients with atumor size of ≥ 3 cm showed a significant dose-response relationship. The observed 2-yearlocal recurrence-free survival rates in patients with a tumor size of < 3 cm and in those witha tumor size of ≥ 3 cm were 96.2% and 50.0%, respectively, which were significantlydifferent (p=0.007). ConclusionBED > 100 Gy is required in order to achieve a > 85% local control rate regardless of tumorsize. The optimal dose for small tumors of < 3 cm appears to be within a range below 150Gy BED. Escalation of BED to high levels (> 150 Gy) may be required for patients with atumor size larger than 3 cm.

폐암의 정위적 체부 방사선치료 시 체적 설정과 호흡주기에 따른 선량평가

이득희,박은태,김정훈,강세식 대한방사선과학회 2016 방사선기술과학 Vol.39 No.3

Stereotactic body radiotherapy is effective technic in radiotherapy for low stage lung cancer. But lung cancer is affected by respiratory so accurately concentrate high dose to the target is very difficult. In this study, evaluated the target volume according to how to take the image. And evaluated the dose by photoluminescence glass dosimeter according to how to contour the volume and respiratory range. As a result, evaluated the 4D CT volume was 10.4 cm3 which was closest value of real size target. And in dose case is internal target volume dose was 10.82, 16.88, 21.90 Gy when prescribed dose was 10, 15, 20 Gy and it was the highest dose. Respiratory gated radiotherapy dose was more higher than internal target volume. But it made little difference by respiratory range. Therefore, when moving cancer treatment, acquiring image by 4D CT, contouring internal target volume and respiratory gated radiotherapy technic would be the best way.

PIVKA-II as a surrogate marker for prognosis in patients with localized hepatocellular carcinoma receiving stereotactic body radiotherapy

Ick Joon Cho,Jae-Uk Jeong,Taek-Keun Nam,Young-Eun Joo,Sung-Bum Cho,Yong-Hyub Kim,Ju-Young Song,Mee Sun Yoon,Sung-Ja Ahn,Woong-Ki Chung 대한방사선종양학회 2022 Radiation Oncology Journal Vol.40 No.1

Purpose: This study aimed to determine the correlation between protein induced by vitamin K absence or antagonist-II (PIVKA-II) and stereotactic body radiotherapy (SBRT) in patients with hepatocellular carcinoma (HCC). Materials and Methods: Sixty-one patients received SBRT between 2015 and 2020 with a median dose of 48 Gy (range, 39 to 60 Gy) with a median of 4 fractions. Changes in tumor markers before and after SBRT were analyzed. Results: The median follow-up period was 31 months (range, 12 to 64 months). The estimated 2-year in-field failure-free survival, progression-free survival (PFS), and overall survival rates were 82.0%, 39.3%, and 96.7%, respectively. Patients with decreased PIVKA-II levels through SBRT had significantly few in-field failures (p = 0.005). Patients with PIVKA-II levels of ≤25 mAU/mL after SBRT had significantly long PFS (p = 0.004). Conclusion: PIVKA-II could be a useful surrogate marker for response or survival outcomes in patients with localized HCC receiving SBRT.