TY - JOUR
T1 - Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma
T2 - Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines
AU - Bae, Sun Hyun
AU - Chun, Seok-Joo
AU - Chung, Joo-Hyun
AU - Kim, Eunji
AU - Kang, Jin-Kyu
AU - Jang, Won Il
AU - Moon, Ji Eun
AU - Roquette, Isaure
AU - Mirabel, Xavier
AU - Kimura, Tomoki
AU - Ueno, Masayuki
AU - Su, Ting-Shi
AU - Tree, Alison C.
AU - Guckenberger, Matthias
AU - Lo, Simon S.
AU - Scorsetti, Marta
AU - Slotman, Ben J.
AU - Kotecha, Rupesh
AU - Sahgal, Arjun
AU - Louie, Alexander V.
AU - Kim, Mi-Sook
N1 - Funding Information: This work was supported by a grant ( 50572-2023 ) from the Korea Institute of Radiological and Medical Sciences (KIRAMS) , funded by the Ministry of Science and ICT (MSIT) , Republic of Korea. This work was also supported by the Soonchunhyang University Research Fund . No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We acknowledge NHS funding to the National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden and the Institute of Cancer Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Funding Information: Disclosures: A.C.T. acknowledges the support of Cancer Research UK (grant numbers C7224/A28724 and C33589/A28284 ). S.S.L. reports the following: Kuni Foundation, research funding; Hutchinson Center as Lead Academic Participating Site , grant UG1 CA 233328 ; Japanese Society for Radiation Oncology, travel expenses; American College of Radiology, alternate councilor on behalf of the American Radium Society, and chair of the Council of Affiliated Regional Radiation Oncology Societies Nominating Committee; Radiosurgery Society, member of Board of Directors, and National Medical Director of the Distinction in Practice in the Stereotactic Radiotherapy Program. R.K. receives honoraria from Accuray Inc, Elekta AB, ViewRay Inc, Novocure Inc, Elsevier Inc, and Brainlab, and institutional research funding from Medtronic Inc, Blue Earth Diagnostics Ltd, Novocure Inc, GT Medical Technologies, AstraZeneca, Exelixis, ViewRay Inc, and Brainlab. A.S. is an advisor/consultant with AbbVie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), Brainlab, and VieCure (Medical Advisory Board); is a vice president of the International Stereotactic Radiosurgery Society; has had past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), Brainlab, AstraZeneca, and Seagen Inc; received research grants from Elekta AB, Varian, Seagen Inc, and Brainlab; received travel accommodations/expenses from Elekta, Varian, and Brainlab; is a cochair of the AO Spine Knowledge Forum Tumor; is a member of the Elekta MR Linac Research Consortium; is a Clinical Steering Committee member; and chairs the Elekta Oligometastases Group and the Elekta Gamma Knife Icon Group. A.V.L. has received honoraria from AstraZeneca for advisory board and speakers bureau participation. All other authors report no conflicts of interest. Publisher Copyright: © 2023 The Authors
PY - 2023
Y1 - 2023
N2 - This systematic review and meta-analysis reports on outcomes and hepatic toxicity rates after stereotactic body radiation therapy (SBRT) for liver-confined hepatocellular carcinoma (HCC) and presents consensus guidelines regarding appropriate patient management. Using the Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines, a systematic review was performed from articles reporting outcomes at ≥5 years published before October 2022 from the Embase, MEDLINE, Cochrane, and Scopus databases with the following search terms: (“stereotactic body radiotherapy” OR “SBRT” OR “SABR” OR “stereotactic ablative radiotherapy”) AND (“hepatocellular carcinoma” OR “HCC”). An aggregated data meta-analysis was conducted to assess overall survival (OS) and local control (LC) using weighted random effects models. In addition, individual patient data analyses incorporating data from 6 institutions were conducted as their own subgroup analyses. Seventeen observational studies, comprising 1889 patients with HCC treated with ≤9 SBRT fractions, between 2003 and 2019, were included in the aggregated data meta-analysis. The 3- and 5-year OS rates after SBRT were 57% (95% confidence interval [CI], 47%-66%) and 40% (95% CI, 29%-51%), respectively. The 3- and 5-year LC rates after SBRT were 84% (95% CI, 77%-90%) and 82% (95% CI, 74%-88%), respectively. Tumor size was the only prognostic factor for LC. Tumor size and region were significantly associated with OS. Five-year LC and OS rates of 79% (95% CI, 0.74-0.84) and 25% (95% CI, 0.20-0.30), respectively, were observed in the individual patient data analyses. Factors prognostic for improved OS were tumor size <3 cm, Eastern region, Child-Pugh score ≤B7, and the Barcelona Clinic Liver Cancer stage of 0 and A. The incidence of severe hepatic toxicity varied according to the criteria applied. SBRT is an effective treatment modality for patients with HCC with mature follow-up. Clinical practice guidelines were developed on behalf of the International Stereotactic Radiosurgery Society (ISRS).
AB - This systematic review and meta-analysis reports on outcomes and hepatic toxicity rates after stereotactic body radiation therapy (SBRT) for liver-confined hepatocellular carcinoma (HCC) and presents consensus guidelines regarding appropriate patient management. Using the Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines, a systematic review was performed from articles reporting outcomes at ≥5 years published before October 2022 from the Embase, MEDLINE, Cochrane, and Scopus databases with the following search terms: (“stereotactic body radiotherapy” OR “SBRT” OR “SABR” OR “stereotactic ablative radiotherapy”) AND (“hepatocellular carcinoma” OR “HCC”). An aggregated data meta-analysis was conducted to assess overall survival (OS) and local control (LC) using weighted random effects models. In addition, individual patient data analyses incorporating data from 6 institutions were conducted as their own subgroup analyses. Seventeen observational studies, comprising 1889 patients with HCC treated with ≤9 SBRT fractions, between 2003 and 2019, were included in the aggregated data meta-analysis. The 3- and 5-year OS rates after SBRT were 57% (95% confidence interval [CI], 47%-66%) and 40% (95% CI, 29%-51%), respectively. The 3- and 5-year LC rates after SBRT were 84% (95% CI, 77%-90%) and 82% (95% CI, 74%-88%), respectively. Tumor size was the only prognostic factor for LC. Tumor size and region were significantly associated with OS. Five-year LC and OS rates of 79% (95% CI, 0.74-0.84) and 25% (95% CI, 0.20-0.30), respectively, were observed in the individual patient data analyses. Factors prognostic for improved OS were tumor size <3 cm, Eastern region, Child-Pugh score ≤B7, and the Barcelona Clinic Liver Cancer stage of 0 and A. The incidence of severe hepatic toxicity varied according to the criteria applied. SBRT is an effective treatment modality for patients with HCC with mature follow-up. Clinical practice guidelines were developed on behalf of the International Stereotactic Radiosurgery Society (ISRS).
UR - http://www.scopus.com/inward/record.url?scp=85171372440&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijrobp.2023.08.015
DO - https://doi.org/10.1016/j.ijrobp.2023.08.015
M3 - Review article
C2 - 37597757
SN - 0360-3016
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
ER -