Individualized adaptive stereotactic body radiation therapy (SBRT) based on liver biomarkers may be highly effective and safe without increasing relapse risk in patients with hepatocellular carcinoma who have had pre-existing liver dysfunction, according to a study published in JAMA Oncology.1
For this phase 2 study (ClinicalTrials.gov Identifier: NCT01522937), researchers enrolled 90 previously treated patients with intrahepatic cancer and measured indocyanine green retention at 15 minutes (ICGR15) to assess liver function. Three of the 5 planned SBRT treatments were then administered, and 4 weeks later ICGR15 was reassessed and results were used to adjust the final 2 doses of SBRT.
Sixty-two patients received all 5 fractions of SBRT, with 15 patients receiving dose-reduced fractions due to an above-threshold ICGR15 measurement at reassessment.
The 1-year control rate was 99% (95% CI, 97-100), the 2-year control rate was 95% (95% CI, 91-99), and the median time to progression was 9 months.
The overall survival at 1-year was 67% (95% CI, 58-78), and at 2 years was 36% (95% CI, 27-48).
Complications occurred at a lower rate than estimated, with 7% of patients experiencing a 2-point decline in Child-Pugh score 6 months after receiving SBRT.
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The authors concluded that “this strategy of individualized adaptive radiotherapy may represent a new treatment paradigm in which dose is based on individual, rather than population-based, tolerance to treatment.”
- Feng M, Suresh K, Schipper MJ, et al. Individualized adaptive stereotactic body radiotherapy for liver tumors in patients at high risk for liver damage. 2017 Aug 10. JAMA Oncol. doi: 10.1001/jamaoncol.2017.2303 [Epub ahead of print]