1. Image-Guided Liver Stereotactic Body Radiotherapy Using VMAT and Real-Time Adaptive Tumor Gating: Evaluation of the Efficacy and Toxicity for Hepatocellular Carcinoma
- Author
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Morgane Creoff, Morgan Michalet, Olivier Riou, Florence Castan, Boris Guiu, Eric Assenat, Jessica Prunaretty, Georges-Philippe Pageaux, Marie Cantaloube, Marc Ychou, N. Aillères, David Azria, Karl Bordeau, Pascal Fenoglietto, Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut du Cancer de Montpellier (ICM), Oncodoc, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département d'Hépato-Gastroentérologie et de Transplantation Hépatique [CHU Saint-Eloi], Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM), and Salvy-Córdoba, Nathalie
- Subjects
Cancer Research ,medicine.medical_specialty ,Multivariate analysis ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,VMAT ,[SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine ,stereotactic body radiation therapy ,liver ,Dose constraints ,Article ,[SDV.IB.MN] Life Sciences [q-bio]/Bioengineering/Nuclear medicine ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,Medicine ,In patient ,hepatocellular carcinoma ,RC254-282 ,business.industry ,Cancer ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,medicine.disease ,[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Oncology ,Hepatocellular carcinoma ,Toxicity ,Cohort ,Radiology ,business ,Stereotactic body radiotherapy - Abstract
Simple Summary Although the use of stereotactic body radiation therapy (SBRT) in the management of hepatocellular carcinoma (HCC) remains unclear, it is a therapeutic option often considered in patients not eligible to or recurring after other local therapies. Liver SBRT can be delivered using a wide range of techniques and linear accelerators. We report the first evaluation for HCC of SBRT using volumetric modulated arc therapy (VMAT) and real-time adaptive tumor gating, which is a mainly completely non-invasive procedure (no fiducial markers for 65.2% of the patients). Our study showed that this SBRT technique has very favorable outcomes with optimal local control and a low toxicity rate. Abstract Liver SBRT is a therapeutic option for the treatment of HCC in patients not eligible for other local therapies. We retrospectively report the outcomes of a cohort of consecutive patients treated with SBRT for HCC at the Montpellier Cancer Institute. Between March 2013 and December 2018, 66 patients were treated with image-guided liver SBRT using VMAT and real-time adaptive tumor gating in our institute. The main endpoints considered in this study were local control, disease-free survival, overall survival, and toxicity. The median follow-up was 16.8 months. About 66.7% had prior liver treatment. Most patients received 50 Gy in five fractions of 10 Gy. No patient had local recurrence. Overall survival and disease-free survival were, respectively, 83.9% and 46.7% at one year. In multivariate analysis, the diameter of the lesions was a significant prognostic factor associated with disease-free survival (HR = 2.57 (1.19–5.53) p = 0.02). Regarding overall survival, the volume of PTV was associated with lower overall survival (HR = 2.84 (1.14–7.08) p = 0.025). No grade 3 toxicity was observed. One patient developed a grade 4 gastric ulcer, despite the dose constraints being respected. Image-guided liver SBRT with VMAT is an effective and safe treatment in patients with inoperable HCC, even in heavily pre-treated patients. Further prospective evaluation will help to clarify the role of SBRT in the management of HCC patients.
- Published
- 2021