Rethinking the role of radiation therapy in the treatment of unresectable hepatocellular carcinoma

A data driven treatment algorithm for optimizing outcomes

Mutlay Sayan, Nikhil Yegya-Raman, Stephanie H. Greco, Bin Gui, Andrew Zhang, Anupama Chundury, Miral S. Grandhi, Howard S. Hochster, Timothy Kennedy, Russell C. Langan, Usha Malhotra, Vinod Rustgi, Mihir M. Shah, Kristen R. Spencer, Darren Carpizo, John L. Nosher, Salma Jabbour

Research output: Contribution to journalReview article

Abstract

Hepatocellular carcinoma (HCC) is the second most common cause of cancer death worldwide, with a majority of HCC patients not suitable for curative therapies. Approximately 70% of initially diagnosed patients cannot undergo surgical resection or transplantation due to locally advanced disease, poor liver function/underlying cirrhosis, or additional comorbidities. Local therapeutic options for patients with unresectable HCC, who are not suitable for thermal ablation, include transarterial embolization (bland, chemoembolization, radioembolization) and/or external beam radiation therapy (EBRT). Regarding EBRT specifically, technological advancements provide a means for safe and effective radiotherapy delivery in a wide spectrum of HCC patients. In multiple prospective studies, EBRT delivery in a variety of different fractionation schemes or in combination with transcatheter arterial chemoembolization (TACE) demonstrate improved outcomes, particularly with combination therapy. The Barcelona Clinic Liver Cancer classification provides a framework for treatment selection; however, given the growing complexity of treatment strategies, this classification system tends to simplify decision-making. In this review, we discuss the current literature regarding unresectable HCC and propose a modified treatment algorithm that emphasizes the role of radiation therapy for Child-Pugh score A or B patients with ≤3 nodules measuring >3 cm, multinodular disease or portal venous thrombosis.

Original languageEnglish (US)
JournalFrontiers in Oncology
Volume9
Issue numberJUN
DOIs
StatePublished - Jan 1 2019

Fingerprint

Hepatocellular Carcinoma
Radiotherapy
Therapeutics
Liver Neoplasms
Venous Thrombosis
Comorbidity
Liver Diseases
Cause of Death
Decision Making
Fibrosis
Hot Temperature
Transplantation
Prospective Studies
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Keywords

  • Hepatocellular carcinoma
  • Radiation therapy
  • Systemic therapy
  • Transarterial embolization
  • Transcatheter arterial chemoembolization

Cite this

Sayan, Mutlay ; Yegya-Raman, Nikhil ; Greco, Stephanie H. ; Gui, Bin ; Zhang, Andrew ; Chundury, Anupama ; Grandhi, Miral S. ; Hochster, Howard S. ; Kennedy, Timothy ; Langan, Russell C. ; Malhotra, Usha ; Rustgi, Vinod ; Shah, Mihir M. ; Spencer, Kristen R. ; Carpizo, Darren ; Nosher, John L. ; Jabbour, Salma. / Rethinking the role of radiation therapy in the treatment of unresectable hepatocellular carcinoma : A data driven treatment algorithm for optimizing outcomes. In: Frontiers in Oncology. 2019 ; Vol. 9, No. JUN.
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abstract = "Hepatocellular carcinoma (HCC) is the second most common cause of cancer death worldwide, with a majority of HCC patients not suitable for curative therapies. Approximately 70{\%} of initially diagnosed patients cannot undergo surgical resection or transplantation due to locally advanced disease, poor liver function/underlying cirrhosis, or additional comorbidities. Local therapeutic options for patients with unresectable HCC, who are not suitable for thermal ablation, include transarterial embolization (bland, chemoembolization, radioembolization) and/or external beam radiation therapy (EBRT). Regarding EBRT specifically, technological advancements provide a means for safe and effective radiotherapy delivery in a wide spectrum of HCC patients. In multiple prospective studies, EBRT delivery in a variety of different fractionation schemes or in combination with transcatheter arterial chemoembolization (TACE) demonstrate improved outcomes, particularly with combination therapy. The Barcelona Clinic Liver Cancer classification provides a framework for treatment selection; however, given the growing complexity of treatment strategies, this classification system tends to simplify decision-making. In this review, we discuss the current literature regarding unresectable HCC and propose a modified treatment algorithm that emphasizes the role of radiation therapy for Child-Pugh score A or B patients with ≤3 nodules measuring >3 cm, multinodular disease or portal venous thrombosis.",
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Rethinking the role of radiation therapy in the treatment of unresectable hepatocellular carcinoma : A data driven treatment algorithm for optimizing outcomes. / Sayan, Mutlay; Yegya-Raman, Nikhil; Greco, Stephanie H.; Gui, Bin; Zhang, Andrew; Chundury, Anupama; Grandhi, Miral S.; Hochster, Howard S.; Kennedy, Timothy; Langan, Russell C.; Malhotra, Usha; Rustgi, Vinod; Shah, Mihir M.; Spencer, Kristen R.; Carpizo, Darren; Nosher, John L.; Jabbour, Salma.

In: Frontiers in Oncology, Vol. 9, No. JUN, 01.01.2019.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Rethinking the role of radiation therapy in the treatment of unresectable hepatocellular carcinoma

T2 - A data driven treatment algorithm for optimizing outcomes

AU - Sayan, Mutlay

AU - Yegya-Raman, Nikhil

AU - Greco, Stephanie H.

AU - Gui, Bin

AU - Zhang, Andrew

AU - Chundury, Anupama

AU - Grandhi, Miral S.

AU - Hochster, Howard S.

AU - Kennedy, Timothy

AU - Langan, Russell C.

AU - Malhotra, Usha

AU - Rustgi, Vinod

AU - Shah, Mihir M.

AU - Spencer, Kristen R.

AU - Carpizo, Darren

AU - Nosher, John L.

AU - Jabbour, Salma

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Hepatocellular carcinoma (HCC) is the second most common cause of cancer death worldwide, with a majority of HCC patients not suitable for curative therapies. Approximately 70% of initially diagnosed patients cannot undergo surgical resection or transplantation due to locally advanced disease, poor liver function/underlying cirrhosis, or additional comorbidities. Local therapeutic options for patients with unresectable HCC, who are not suitable for thermal ablation, include transarterial embolization (bland, chemoembolization, radioembolization) and/or external beam radiation therapy (EBRT). Regarding EBRT specifically, technological advancements provide a means for safe and effective radiotherapy delivery in a wide spectrum of HCC patients. In multiple prospective studies, EBRT delivery in a variety of different fractionation schemes or in combination with transcatheter arterial chemoembolization (TACE) demonstrate improved outcomes, particularly with combination therapy. The Barcelona Clinic Liver Cancer classification provides a framework for treatment selection; however, given the growing complexity of treatment strategies, this classification system tends to simplify decision-making. In this review, we discuss the current literature regarding unresectable HCC and propose a modified treatment algorithm that emphasizes the role of radiation therapy for Child-Pugh score A or B patients with ≤3 nodules measuring >3 cm, multinodular disease or portal venous thrombosis.

AB - Hepatocellular carcinoma (HCC) is the second most common cause of cancer death worldwide, with a majority of HCC patients not suitable for curative therapies. Approximately 70% of initially diagnosed patients cannot undergo surgical resection or transplantation due to locally advanced disease, poor liver function/underlying cirrhosis, or additional comorbidities. Local therapeutic options for patients with unresectable HCC, who are not suitable for thermal ablation, include transarterial embolization (bland, chemoembolization, radioembolization) and/or external beam radiation therapy (EBRT). Regarding EBRT specifically, technological advancements provide a means for safe and effective radiotherapy delivery in a wide spectrum of HCC patients. In multiple prospective studies, EBRT delivery in a variety of different fractionation schemes or in combination with transcatheter arterial chemoembolization (TACE) demonstrate improved outcomes, particularly with combination therapy. The Barcelona Clinic Liver Cancer classification provides a framework for treatment selection; however, given the growing complexity of treatment strategies, this classification system tends to simplify decision-making. In this review, we discuss the current literature regarding unresectable HCC and propose a modified treatment algorithm that emphasizes the role of radiation therapy for Child-Pugh score A or B patients with ≤3 nodules measuring >3 cm, multinodular disease or portal venous thrombosis.

KW - Hepatocellular carcinoma

KW - Radiation therapy

KW - Systemic therapy

KW - Transarterial embolization

KW - Transcatheter arterial chemoembolization

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