An overview of stereotactic body radiation therapy for hepatocellular carcinoma
Tomoki Kimura, Yoshiko Doi, Sigeo Takahashi, Katsumaro Kubo, Nobuki Imano, Yuki Takeuchi, show all
Pages 271-279 | Received 22 Dec 2019, Accepted 16 Mar 2020, Published online: 30 Mar 2020
Introduction: According to several guidelines, stereotactic body radiation therapy (SBRT) for early hepatocellular carcinoma (HCC) can be considered an alternative to other modalities, such as resection, radiofrequency ablation (RFA), and transarterial chemoembolization (TACE), or when these therapies have failed or are contraindicated. This article reviews the current status of SBRT for the treatment of HCC.
Areas covered: From the results of many retrospective reports, SBRT is a promising modality with an excellent local control of almost 90% at 2–3 years and acceptable toxicities. Currently there are no randomized trials to compare SBRT and other modalities, such as resection, RFA, and TACE, but many retrospective reports and propensity score matching have shown that SBRT is comparable to the different modalities. Repeated SBRT for intra-hepatic recurrent HCC also resulted in high local control with safety and satisfactory overall survival, which were comparable to those of other curative local treatments.
Expert opinion: Despite the good results of SBRT, the conclusions of the comparisons of SBRT and other modalities are still controversial. Further studies, including randomized phase III studies to define that patients are more suitable for each curative local treatment, are needed.
KEYWORDS: Stereotactic body radiotherapy (SBRT), hepatocellular carcinoma (HCC), resection, radiofrequency ablation (RFA), transarterial chemoembolization (TACE)
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Article highlights
According to several guidelines, SBRT can be considered an alternative to ablation/embolization or when these therapies have failed or are contraindicated.
Promising results of SBRT have been reported in early HCC, with high local control (LC) rates that generally range from 70-100% at 2-3 years and overall survival rates that range from 60-70%.
The most frequent adverse effects were generally mild, and associated with liver injury, such as the elevation of total bilirubin and transaminase and the decrease of platelets and ascites. Gastrointestinal toxicities, central biliary tract stenosis, and portal vein thrombosis should be evaluated as low incident toxicities.
For evaluation after SBRT, residual early arterial enhancement disappeared within 6 months in most cases. An early assessment within 3 months may result in a misleading response evaluation.
Currently there are no randomized trials to compare SBRT and other modalities, such as resection, RFA, and TACE, but many retrospective reports and propensity score matching reports, for the comparison of the different modalities, have been published. Compared to TACE, SBRT could improve LC. Compared to RFA and resection, the results are still controversial.
Combining SBRT and immune checkpoint inhibitor has shown promising data.作者: StephenW 时间: 2020-4-1 13:26