Smith Apisarnthanarax1, Aisling Barry2, Minsong Cao3, Brian Czito4, Ronald DeMatteo5, Mary Drinane6, Christopher L Hallemeier7, Eugene J Koay8, Foster Lasley9, Jeffrey Meyer10, Dawn Owen7, Jennifer Pursley11, Stephanie K Schaub12, Grace Smith8, Neeta K Venepalli13, Gazi Zibari14, Higinia Cardenes15. 1. Department of Radiation Oncology, University of Washington, Seattle, Washington. Electronic address: apisarn@uw.edu. 2. Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada. 3. Department of Radiation Oncology, University of California, Los Angeles, California. 4. Department of Radiation Oncology, Duke University, Durham, North Carolina. 5. Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. 6. Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 7. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. 8. Department of Radiation Oncology, UT-MD Anderson Cancer Center, Houston, Texas. 9. Department of Radiation Oncology, GenesisCare, Rogers, Arkansas. 10. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland. 11. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. 12. Department of Radiation Oncology, University of Washington, Seattle, Washington. 13. Department of Medicine, University of North Carolina, Chapel Hill, North Carolina. 14. Department of Transplantation Services, Willis-Knighton Medical Center, Shreveport, Louisiana. 15. Department of Radiation Oncology, Weill Cornell, New York, New York.
Abstract
PURPOSE: This guideline provides evidence-based recommendations for the indications and technique-dose of external beam radiation therapy (EBRT) in hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC). METHODS: The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the indications, techniques, and outcomes of EBRT in HCC and IHC. This guideline is intended to cover the definitive, consolidative, salvage, preoperative (including bridge to transplant), and adjuvant settings as well as palliative EBRT for symptomatic primary lesions. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: Strong recommendations are made for using EBRT as a potential first-line treatment in patients with liver-confined HCC who are not candidates for curative therapy, as consolidative therapy after incomplete response to liver-directed therapies, and as a salvage option for local recurrences. The guideline conditionally recommends EBRT for patients with liver-confined multifocal or unresectable HCC or those with macrovascular invasion, sequenced with systemic or catheter-based therapies. Palliative EBRT is conditionally recommended for symptomatic primary HCC and/or macrovascular tumor thrombi. EBRT is conditionally recommended as a bridge to transplant or before surgery in carefully selected patients. For patients with unresectable IHC, consolidative EBRT with or without chemotherapy should be considered, typically after systemic therapy. Adjuvant EBRT is conditionally recommended for resected IHC with high-risk features. Selection of dose-fractionation regimen and technique should be based on disease extent, disease location, underlying liver function, and available technologies. CONCLUSIONS: The task force has proposed recommendations to inform best clinical practices on the use of EBRT for HCC and IHC with strong emphasis on multidisciplinary care. Future studies should focus on further defining the role of EBRT in the context of liver-directed and systemic therapies and refining optimal regimens and techniques.
PURPOSE: This guideline provides evidence-based recommendations for the indications and technique-dose of external beam radiation therapy (EBRT) in hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC). METHODS: The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the indications, techniques, and outcomes of EBRT in HCC and IHC. This guideline is intended to cover the definitive, consolidative, salvage, preoperative (including bridge to transplant), and adjuvant settings as well as palliative EBRT for symptomatic primary lesions. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: Strong recommendations are made for using EBRT as a potential first-line treatment in patients with liver-confined HCC who are not candidates for curative therapy, as consolidative therapy after incomplete response to liver-directed therapies, and as a salvage option for local recurrences. The guideline conditionally recommends EBRT for patients with liver-confined multifocal or unresectable HCC or those with macrovascular invasion, sequenced with systemic or catheter-based therapies. Palliative EBRT is conditionally recommended for symptomatic primary HCC and/or macrovascular tumor thrombi. EBRT is conditionally recommended as a bridge to transplant or before surgery in carefully selected patients. For patients with unresectable IHC, consolidative EBRT with or without chemotherapy should be considered, typically after systemic therapy. Adjuvant EBRT is conditionally recommended for resected IHC with high-risk features. Selection of dose-fractionation regimen and technique should be based on disease extent, disease location, underlying liver function, and available technologies. CONCLUSIONS: The task force has proposed recommendations to inform best clinical practices on the use of EBRT for HCC and IHC with strong emphasis on multidisciplinary care. Future studies should focus on further defining the role of EBRT in the context of liver-directed and systemic therapies and refining optimal regimens and techniques.
Authors: Brian De; Hop S Tran Cao; Jean-Nicolas Vauthey; Gohar S Manzar; Kelsey L Corrigan; Kanwal P S Raghav; Sunyoung S Lee; Ching-Wei D Tzeng; Bruce D Minsky; Grace L Smith; Emma B Holliday; Cullen M Taniguchi; Albert C Koong; Prajnan Das; Milind Javle; Ethan B Ludmir; Eugene J Koay Journal: Cancer Date: 2022-04-13 Impact factor: 6.921
Authors: Danijel Galun; Dragana Mijac; Aleksandar Filipovic; Aleksandar Bogdanovic; Marko Zivanovic; Dragan Masulovic Journal: J Pers Med Date: 2022-01-24
Authors: Gohar Shahwar Manzar; Brian Sandeep De; Chike Osita Abana; Sunyoung S Lee; Milind Javle; Ahmed O Kaseb; Jean-Nicolas Vauthey; Hop Sanderson Tran Cao; Albert C Koong; Grace Li Smith; Cullen M Taniguchi; Emma Brey Holliday; Prajnan Das; Eugene Jon Koay; Ethan Bernard Ludmir Journal: Cancers (Basel) Date: 2022-04-09 Impact factor: 6.575