Strahlentherapie-Dosiseskalation nach unvollständiger transarterieller Chemoembolisation bei hepatozellulärem Karzinom

Translated title of the contribution: Dose escalation in radiotherapy for incomplete transarterial chemoembolization of hepatocellular carcinoma

Hwa Kyung Byun, Hyun Ju Kim, Yoo Ri Im, doyoung kim, KwangHyub Han, Jinsil Seong

Research output: Contribution to journalArticle

Abstract

Purpose: To investigate the efficacy of radiation dose escalation in patients with hepatocellular carcinoma (HCC) after incomplete transarterial chemoembolization (TACE). Methods: This study evaluated retrospective data of 323 HCC patients who received radiotherapy after incomplete TACE from 2001–2016. Radiation dose in biologically effective dose (BED) (α/β = 10) was categorized as <72 Gy (261 patients) and ≥72 Gy (62 patients). Simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) was used significantly more frequently in the high-dose group (64.5% vs. 12.9%; P < 0.001). Local failure-free rate (LFFR), progression-free rate (PFR), and toxicities were compared between the two groups. Additionally, propensity score matching was performed. Results: Median follow-up time for patients who were alive at the time of analysis was 47 months (range 18–189 months). Median overall survival after radiotherapy was 14 months. In multivariate analysis, BED ≥72 Gy was an independent predictor of favorable LFFR (hazard ratio [HR] 0.32; 95% confidence interval [CI] 0.14–0.72; P = 0.006) and PFR (HR 0.67; 95% CI 0.45–0.98; P = 0.04). In the propensity score-matched cohort (62 pairs), 1‑year LFFR (94% vs. 81%; P = 0.002), and 1‑year PFR (49% vs. 42%; P = 0.01) were significantly higher in the high-dose group. Treatment-related toxicities were comparable between the high-dose and low-dose groups (classic radiation-induced liver disease: 5.3% [3/57] vs. 13.8% [29/210], P = 0.08; grade 2–4 gastrointestinal bleeding: 3.2% [2/62] vs. 7.3% [19/261], P = 0.39). Conclusion: Radiation dose with BED ≥72 Gy improved LFFR and PFR without increasing toxicity. In radiotherapy for incomplete TACE of HCC, dose escalation using SIB-IMRT should be actively considered to improve oncologic outcome.

Original languageGerman
JournalStrahlentherapie und Onkologie
DOIs
Publication statusPublished - 2019 Jan 1

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Hepatocellular Carcinoma
Radiotherapy
Radiation
Propensity Score
Confidence Intervals
Liver Diseases
Multivariate Analysis
Retrospective Studies
Hemorrhage
Survival
Therapeutics

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Oncology

Cite this

@article{94df5657d280493793d8e00c4fa0743b,
title = "Strahlentherapie-Dosiseskalation nach unvollst{\"a}ndiger transarterieller Chemoembolisation bei hepatozellul{\"a}rem Karzinom",
abstract = "Purpose: To investigate the efficacy of radiation dose escalation in patients with hepatocellular carcinoma (HCC) after incomplete transarterial chemoembolization (TACE). Methods: This study evaluated retrospective data of 323 HCC patients who received radiotherapy after incomplete TACE from 2001–2016. Radiation dose in biologically effective dose (BED) (α/β = 10) was categorized as <72 Gy (261 patients) and ≥72 Gy (62 patients). Simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) was used significantly more frequently in the high-dose group (64.5{\%} vs. 12.9{\%}; P < 0.001). Local failure-free rate (LFFR), progression-free rate (PFR), and toxicities were compared between the two groups. Additionally, propensity score matching was performed. Results: Median follow-up time for patients who were alive at the time of analysis was 47 months (range 18–189 months). Median overall survival after radiotherapy was 14 months. In multivariate analysis, BED ≥72 Gy was an independent predictor of favorable LFFR (hazard ratio [HR] 0.32; 95{\%} confidence interval [CI] 0.14–0.72; P = 0.006) and PFR (HR 0.67; 95{\%} CI 0.45–0.98; P = 0.04). In the propensity score-matched cohort (62 pairs), 1‑year LFFR (94{\%} vs. 81{\%}; P = 0.002), and 1‑year PFR (49{\%} vs. 42{\%}; P = 0.01) were significantly higher in the high-dose group. Treatment-related toxicities were comparable between the high-dose and low-dose groups (classic radiation-induced liver disease: 5.3{\%} [3/57] vs. 13.8{\%} [29/210], P = 0.08; grade 2–4 gastrointestinal bleeding: 3.2{\%} [2/62] vs. 7.3{\%} [19/261], P = 0.39). Conclusion: Radiation dose with BED ≥72 Gy improved LFFR and PFR without increasing toxicity. In radiotherapy for incomplete TACE of HCC, dose escalation using SIB-IMRT should be actively considered to improve oncologic outcome.",
author = "Byun, {Hwa Kyung} and Kim, {Hyun Ju} and Im, {Yoo Ri} and doyoung kim and KwangHyub Han and Jinsil Seong",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00066-019-01488-9",
language = "German",
journal = "Strahlentherapie und Onkologie",
issn = "0179-7158",
publisher = "Urban und Vogel",

}

TY - JOUR

T1 - Strahlentherapie-Dosiseskalation nach unvollständiger transarterieller Chemoembolisation bei hepatozellulärem Karzinom

AU - Byun, Hwa Kyung

AU - Kim, Hyun Ju

AU - Im, Yoo Ri

AU - kim, doyoung

AU - Han, KwangHyub

AU - Seong, Jinsil

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To investigate the efficacy of radiation dose escalation in patients with hepatocellular carcinoma (HCC) after incomplete transarterial chemoembolization (TACE). Methods: This study evaluated retrospective data of 323 HCC patients who received radiotherapy after incomplete TACE from 2001–2016. Radiation dose in biologically effective dose (BED) (α/β = 10) was categorized as <72 Gy (261 patients) and ≥72 Gy (62 patients). Simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) was used significantly more frequently in the high-dose group (64.5% vs. 12.9%; P < 0.001). Local failure-free rate (LFFR), progression-free rate (PFR), and toxicities were compared between the two groups. Additionally, propensity score matching was performed. Results: Median follow-up time for patients who were alive at the time of analysis was 47 months (range 18–189 months). Median overall survival after radiotherapy was 14 months. In multivariate analysis, BED ≥72 Gy was an independent predictor of favorable LFFR (hazard ratio [HR] 0.32; 95% confidence interval [CI] 0.14–0.72; P = 0.006) and PFR (HR 0.67; 95% CI 0.45–0.98; P = 0.04). In the propensity score-matched cohort (62 pairs), 1‑year LFFR (94% vs. 81%; P = 0.002), and 1‑year PFR (49% vs. 42%; P = 0.01) were significantly higher in the high-dose group. Treatment-related toxicities were comparable between the high-dose and low-dose groups (classic radiation-induced liver disease: 5.3% [3/57] vs. 13.8% [29/210], P = 0.08; grade 2–4 gastrointestinal bleeding: 3.2% [2/62] vs. 7.3% [19/261], P = 0.39). Conclusion: Radiation dose with BED ≥72 Gy improved LFFR and PFR without increasing toxicity. In radiotherapy for incomplete TACE of HCC, dose escalation using SIB-IMRT should be actively considered to improve oncologic outcome.

AB - Purpose: To investigate the efficacy of radiation dose escalation in patients with hepatocellular carcinoma (HCC) after incomplete transarterial chemoembolization (TACE). Methods: This study evaluated retrospective data of 323 HCC patients who received radiotherapy after incomplete TACE from 2001–2016. Radiation dose in biologically effective dose (BED) (α/β = 10) was categorized as <72 Gy (261 patients) and ≥72 Gy (62 patients). Simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) was used significantly more frequently in the high-dose group (64.5% vs. 12.9%; P < 0.001). Local failure-free rate (LFFR), progression-free rate (PFR), and toxicities were compared between the two groups. Additionally, propensity score matching was performed. Results: Median follow-up time for patients who were alive at the time of analysis was 47 months (range 18–189 months). Median overall survival after radiotherapy was 14 months. In multivariate analysis, BED ≥72 Gy was an independent predictor of favorable LFFR (hazard ratio [HR] 0.32; 95% confidence interval [CI] 0.14–0.72; P = 0.006) and PFR (HR 0.67; 95% CI 0.45–0.98; P = 0.04). In the propensity score-matched cohort (62 pairs), 1‑year LFFR (94% vs. 81%; P = 0.002), and 1‑year PFR (49% vs. 42%; P = 0.01) were significantly higher in the high-dose group. Treatment-related toxicities were comparable between the high-dose and low-dose groups (classic radiation-induced liver disease: 5.3% [3/57] vs. 13.8% [29/210], P = 0.08; grade 2–4 gastrointestinal bleeding: 3.2% [2/62] vs. 7.3% [19/261], P = 0.39). Conclusion: Radiation dose with BED ≥72 Gy improved LFFR and PFR without increasing toxicity. In radiotherapy for incomplete TACE of HCC, dose escalation using SIB-IMRT should be actively considered to improve oncologic outcome.

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U2 - 10.1007/s00066-019-01488-9

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