Michael Buckstein1, Edward Kim2, Aaron Fischman2, Seth Blacksburg3, Marcelo Facciuto4, Myron Schwartz4, Kenneth Rosenzweig1. 1. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 2. Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Department of Radiation Oncology, Winthrop University Hospital, Mineola, NY, USA. 4. Departments of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
BACKGROUND: Transarterial chemoembolization (TACE) is the standard for unresectable Barcelona Clinic Liver Cancer (BCLC) B hepatocellular carcinoma (HCC) patients but is not an ablative therapy. This study explores stereotactic body radiation therapy (SBRT) as an adjuvant or salvage to drug eluting bead (DEB)-TACE. METHODS: A retrospective review identified patients receiving SBRT within 2 years following DEB-TACE to a target lesion. Primary outcome was objective response (OR) using modified response evaluation criteria in solid tumors (mRECIST). Other outcomes included local control (LC), out of field failures, and overall survival (OS). RESULTS: One hundred and three patients were identified with median 2 DEB-TACEs prior to SBRT. Fifty-two patients had planned adjuvant SBRT after DEB-TACE and the remainder had salvage SBRT with no statistical differences between groups. Of 95 patients with follow-up imaging, 59 (62.1%) had a complete response and 25 (26.3%) had a partial response (PR). More patients achieved CR (79.6% vs. 43.5%) with planned TACE + SBRT than salvage (P=0.006). LC was 91% and 89% at 1 and 2 years, respectively. One-year survival for planned DEB-TACE SBRT was 70.8% vs. 61.5% for salvage (P=0.052). CONCLUSIONS: Combination TACE + SBRT achieves high OR and LC rates. Adjuvant TACE + SBRT might achieve superior outcomes than salvage. This strategy might be particularly effective as a bridge to transplant.
BACKGROUND: Transarterial chemoembolization (TACE) is the standard for unresectable Barcelona Clinic Liver Cancer (BCLC) B hepatocellular carcinoma (HCC) patients but is not an ablative therapy. This study explores stereotactic body radiation therapy (SBRT) as an adjuvant or salvage to drug eluting bead (DEB)-TACE. METHODS: A retrospective review identified patients receiving SBRT within 2 years following DEB-TACE to a target lesion. Primary outcome was objective response (OR) using modified response evaluation criteria in solid tumors (mRECIST). Other outcomes included local control (LC), out of field failures, and overall survival (OS). RESULTS: One hundred and three patients were identified with median 2 DEB-TACEs prior to SBRT. Fifty-two patients had planned adjuvant SBRT after DEB-TACE and the remainder had salvage SBRT with no statistical differences between groups. Of 95 patients with follow-up imaging, 59 (62.1%) had a complete response and 25 (26.3%) had a partial response (PR). More patients achieved CR (79.6% vs. 43.5%) with planned TACE + SBRT than salvage (P=0.006). LC was 91% and 89% at 1 and 2 years, respectively. One-year survival for planned DEB-TACE SBRT was 70.8% vs. 61.5% for salvage (P=0.052). CONCLUSIONS: Combination TACE + SBRT achieves high OR and LC rates. Adjuvant TACE + SBRT might achieve superior outcomes than salvage. This strategy might be particularly effective as a bridge to transplant.
Authors: Daniel R Wahl; Matthew H Stenmark; Yebin Tao; Erqi L Pollom; Elaine M Caoili; Theodore S Lawrence; Matthew J Schipper; Mary Feng Journal: J Clin Oncol Date: 2015-11-30 Impact factor: 44.544
Authors: Gonzalo Sapisochin; Aisling Barry; Mark Doherty; Sandra Fischer; Nicolas Goldaracena; Roizar Rosales; Moises Russo; Rob Beecroft; Anand Ghanekar; Mamatha Bhat; James Brierley; Paul D Greig; Jennifer J Knox; Laura A Dawson; David R Grant Journal: J Hepatol Date: 2017-02-28 Impact factor: 25.083
Authors: Regina V Tse; Maria Hawkins; Gina Lockwood; John J Kim; Bernard Cummings; Jennifer Knox; Morris Sherman; Laura A Dawson Journal: J Clin Oncol Date: 2008-01-02 Impact factor: 44.544
Authors: Jacques Ferlay; Isabelle Soerjomataram; Rajesh Dikshit; Sultan Eser; Colin Mathers; Marise Rebelo; Donald Maxwell Parkin; David Forman; Freddie Bray Journal: Int J Cancer Date: 2014-10-09 Impact factor: 7.396
Authors: Johannes Lammer; Katarina Malagari; Thomas Vogl; Frank Pilleul; Alban Denys; Anthony Watkinson; Michael Pitton; Geraldine Sergent; Thomas Pfammatter; Sylvain Terraz; Yves Benhamou; Yves Avajon; Thomas Gruenberger; Maria Pomoni; Herbert Langenberger; Marcus Schuchmann; Jerome Dumortier; Christian Mueller; Patrick Chevallier; Riccardo Lencioni Journal: Cardiovasc Intervent Radiol Date: 2009-11-12 Impact factor: 2.740