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 - Publisher Copyright:
© 2023 The Authors
PY - 2024/2/1
Y1 - 2024/2/1
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 - 10.1016/j.ijrobp.2023.08.015
DO - 10.1016/j.ijrobp.2023.08.015
M3 - Review article
C2 - 37597757
AN - SCOPUS:85171372440
SN - 0360-3016
VL - 118
SP - 337
EP - 351
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 2
ER -