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A mid-treatment break and reassessment maintains tumor control and reduces toxicity in patients with hepatocellular carcinoma treated with stereotactic body radiation therapy.
Jackson, W C; Suresh, K; Maurino, C; Feng, M; Cuneo, K C; Ten Haken, R K; Lawrence, T S; Schipper, M J; Owen, D.
Afiliación
  • Jackson WC; University of Michigan, Department of Radiation Oncology, United States.
  • Suresh K; University of Michigan, Department of Radiation Oncology, United States.
  • Maurino C; University of Michigan, Department of Radiation Oncology, United States.
  • Feng M; University of California San Francisco, Department of Radiation Oncology, United States.
  • Cuneo KC; University of Michigan, Department of Radiation Oncology, United States.
  • Ten Haken RK; University of Michigan, Department of Radiation Oncology, United States.
  • Lawrence TS; University of Michigan, Department of Radiation Oncology, United States.
  • Schipper MJ; University of Michigan, Department of Radiation Oncology, United States.
  • Owen D; University of Michigan, Department of Radiation Oncology, United States. Electronic address: dawnowen@med.umich.edu.
Radiother Oncol ; 141: 101-107, 2019 12.
Article en En | MEDLINE | ID: mdl-31431377
BACKGROUND AND PURPOSE: Patients with hepatocellular carcinoma (HCC) commonly have underlying liver dysfunction with variable tolerance to liver stereotactic body radiation therapy (SBRT). We hypothesized that insertion of a 1-month mid-treatment break would allow us to adapt treatment to the individual patient response, thereby reducing toxicity without compromising local control (LC). MATERIALS AND METHODS: We analyzed HCC patients receiving 3-5 fraction SBRT at our institution from 2005 to 2017. Over this time, patients were offered enrollment on prospective trials assessing individualized adaptive SBRT. Based on normal tissue complication probability and modeling of changes in liver function following a 1-month treatment break between fractions 3 and 4, patients could receive a total of 3 or 5 fractions. Patients not on trial received 3 or 5 fractions without a break. Toxicity was defined as a ≥2 point rise in Child-Pugh (CP) score within 6 months of SBRT. RESULTS: 178 patients were treated with SBRT to 263 HCCs. Median follow-up was 23 months. 86 treatments had a 1-month break. 1-Year LC was 95.4%; this was not different between patients treated with or without a break (p = 0.14). Controlling for tumor size and dose a break was not associated with inferior LC (HR: 0.58, 95%CI: 0.1-3.34, p = 0.54). 54 patients experienced a ≥2 point rise in CP score. Controlling for the number of prior liver directed therapies and mean liver dose, a treatment break reduced the odds of toxicity (OR: 0.42, 95% CI: 0.17-1.03, p = 0.06). CONCLUSION: A one-month mid-treatment break and reassessment may reduce the odds of treatment related toxicity without compromising LC.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos por Radiación / Radiocirugia / Carcinoma Hepatocelular / Neoplasias Hepáticas Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Radiother Oncol Año: 2019 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Irlanda
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos por Radiación / Radiocirugia / Carcinoma Hepatocelular / Neoplasias Hepáticas Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Radiother Oncol Año: 2019 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Irlanda