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6 "Stereotactic body radiotherapy"
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Original Article
Assessment of Real-Time US-CT/MR-guided Percutaneous Gold Fiducial Marker Implementation in Malignant Hepatic Tumors for Stereotactic Body Radiation Therapy
Sungjun Hwang, Seok-Joo Chun, Eui Kyu Chie, Jeong Min Lee
Received March 20, 2024  Accepted June 2, 2024  Published online June 10, 2024  
DOI: https://doi.org/10.17998/jlc.2024.06.03    [Accepted]
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  • 4 Downloads
AbstractAbstract PDF
Background/Aims
This study explored the initial institutional experience of using gold fiducial markers for stereotactic body radiotherapy (SBRT) in treating malignant hepatic tumors using real-time ultrasound-computed tomography (CT)/magnetic resonance (MR) imaging fusion-guided percutaneous placement.
Methods
From May 2021 to August 2023, 19 patients with 25 liver tumors that were invisible on pre-contrast CT received fiducial markers following these guidelines. Postprocedural scans were used to confirm their placement. We assessed technical and clinical success rates and monitored complications. The implantation of fiducial markers facilitating adequate treatment prior to SBRT, which was achieved in 96% of the cases (24 of 25 tumors), was considered technical success. Clinical success was the successful completion of SBRT without evidence of marker displacement and was achieved in 88% of cases (22 of 25 tumors). Complications included one major subcapsular hematoma and marker migration into the right atrium in two cases, which prevented SBRT.
Results
Among the treated tumors, 83.3% (20 of 24) showed a complete response, 12.5% (3 of 24) remained stable, and 4.2% (1 of 24) progressed during an average 11.7-month follow-up (range, 2–32 months).
Conclusions
This study confirms that percutaneous gold fiducial marker placement using real-time CT/MR guidance is effective and safe for SBRT in hepatic tumors, but warns of marker migration risks, especially near the hepatic veins and in subcapsular locations. Using fewer markers than traditionally recommended—typically two per patient), the outcomes were still satisfactory, particularly given the increased risk of migration when markers were placed near major hepatic veins.
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Case Reports
Huge Hepatocellular Carcinoma Exhibiting a Complete Response after Stereotactic Body Radiation Therapy
Kyung In Shin, Byoung Kuk Jang, Jin Hee Kim, Jae Seok Hwang
J Liver Cancer. 2020;20(2):167-172.   Published online September 30, 2020
DOI: https://doi.org/10.17998/jlc.20.2.167
  • 3,026 Views
  • 99 Downloads
AbstractAbstract PDF
To date, there are limited data and little consensus on treatment strategies for huge hepatocellular carcinoma (HCC). Surgical resection provides significantly better survival than other modalities for single large HCC regardless of tumor stage. Recently, with technological advances in radiation therapy, stereotactic body radiation therapy (SBRT) is considered an alternative treatment option for HCC. Herein, we present a case of huge HCC that was successfully managed by SBRT. Transarterial embolization, previously performed in Russia, was incomplete. It was also not suitable for resection and transarterial chemoembolization. Although the rationale for radiotherapy in huge HCC was insufficient, SBRT was performed because no other treatment options were available. Additional radiofrequency ablation was performed for small HCC in a different segment, and radiological complete response (CR) was achieved. The CR was maintained over 4 years. Therefore, SBRT may be an alternative treatment option for large HCC that is not suitable for curative treatment.
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A Case of Small Hepatocellular Carcinoma Who Showed Complete Response by Combined Therapy of Transarterial Chemoembolization and Stereotactic Body Radiotherapy
Cha, Jun Young , Jun, Baek Gyu , Gong, Eun Jeong , Seo, Hyun Il , Park, Jong Kyu , Lee, Sang Jin , Kim, Young Don , Han, Koon Hee , Jeong, Woo Jin , Cheon, Gab Jin , Choi, Won Sik
J Liver Cancer. 2018;18(2):157-161.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.157
  • 2,002 Views
  • 25 Downloads
AbstractAbstract PDF
In hepatocellular carcinoma (HCC), surgical resection or local ablation therapy is limited because of severe liver dysfunction or tumor location. Transarterial chemoembolization (TACE) has beed used widely as palliative treatment. Stereotactic Body Radiotherapy (SBRT) is a more recent and effective treatment for early stage HCC. We report a case with small HCC with complete response by TACE combined with SBRT.
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Original Article
Multicenter Planning Comparison of Stereotactic Body Radiotherapy for Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombosis (KROG 16-17)
Bae, Sun Hyun , Kim, Mi Sook , Jang, Won Il , Kim, Jin Ho , Kim, Woo Chul , Kim, Jin Hee , Jeong, Bae Kwon , Kim, Yong Ho , Jo, Sunmi , Choi, Chul Won , Park, Younghee , Cho, Kwang Hwan
J Liver Cancer. 2018;18(2):130-141.   Published online September 30, 2018
DOI: https://doi.org/10.17998/jlc.18.2.130
  • 4,038 Views
  • 54 Downloads
  • 1 Citation
AbstractAbstract PDF
Background/Aims
To evaluate the technical feasibility of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) with the major portal vein tumor thrombosis (PVTT).
Methods
Ten institutions affiliated with the Korean Stereotactic Radiosurgery Group were provided the contours of four cases: the first case was the first branch PVTT with sufficient normal liver volume (NLV), the second was the first branch PVTT with insufficient NLV, the third was the main trunk PVTT at confluence level, and the fourth was the main trunk PVTT with entire length. The institutions were asked to make SBRT plans according to their current treatment protocols and to complete facility questionnaires.
Results
Based on institutional protocols, SBRT was feasible in nine institutions for the first case (32-60 Gy in 3-5 fractions), in eight institutions for the second case (32-50 Gy in 3-5 fractions), in seven institutions for the third case (35-60 Gy in 3-5 fractions), and in four institutions for the fourth case (35-42 Gy in 4-5 fractions). The other institutions recommended hypo- or conventional fractionation due to insufficient NLV or gastrointestinal organ proximity. With analysis of the SBRT dose to the central hepatobiliary tract, the major PVTT could theoretically be associated with a high risk of hepatobiliary toxicity.
Conclusions
Although SBRT is a technically feasible option for HCC with the major PVTT, there was a variability among the participating institutions. Therefore, further studies will be necessary to standardize the practice of SBRT for the major PVTT.

Citations

Citations to this article as recorded by  
  • Current status of stereotactic body radiotherapy for the treatment of hepatocellular carcinoma
    Jongmoo Park, Jae Won Park, Min Kyu Kang
    Yeungnam University Journal of Medicine.2019; 36(3): 192.     CrossRef
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Case Reports
A Case of Complete Response with Biliary Stenosis after Hepatic Arterial Injection and Stereotactic Body Radiotherapy to Hepatoecllular Carcinoma with Portal Vein Thrombosis
Rim, Chai Hong , Im, Hyung Joon , Jung, Young Geol , Chung, Hwan Hoon , Seo, Sang Joon , Yoon, Won Sup
J Liver Cancer. 2018;18(1):75-79.   Published online March 31, 2018
DOI: https://doi.org/10.17998/jlc.18.1.75
  • 2,056 Views
  • 37 Downloads
AbstractAbstract PDF
Curative treatment of hepatocellular carcinoma (HCC) with portal vein invasion is difficult to achieve, and the prognosis is dismal. Combining external beam radiotherapy (EBRT) with hepatic arterial infusion chemotherapy (HAIC) has shown favorable local therapeutic effects for patients with HCC exhibiting portal vein invasion. Stereotactic body radiotherapy (SBRT) is a recently developed EBRT modality that shows excellent tumor control. The combination of SBRT and HAIC for HCC with portal vein invasion has not been well-studied. We report a patient with HCC and portal vein invasion who achieved 15 months of survival with complete response status after combination SBRT and HAIC. The patient later experienced grade 3 biliary stricture and died of liver abscesses of unknown etiologies that subsequently appeared.
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A Case of Perforation of Gastric Ulcer after Complete Remission of Huge Hepatocellular Carcinoma Invading Main Portal Vein with Combination Therapy of Stereotactic Body Radiation Therapy and Sorafenib
Sang Youn Hwang, Seon-Mi Lee, Jung Woo Im, Joon Suk Kim, Sang Bu Ahn, Eun Kyeong Ji, Chul Won Choi, Gwang-Mo Yang
Journal of the Korean Liver Cancer Study Group. 2014;14(1):46-52.   Published online March 31, 2014
DOI: https://doi.org/10.17998/jlc.14.1.46
  • 1,332 Views
  • 9 Downloads
  • 1 Citation
AbstractAbstract PDF
Hepatocellular carcinoma (HCC) patients with main portal vein invasion have a poor prognosis associated with a median survival time of 2.7 months. Though many guidelines recommended sorafenib in HCC patients with macrovascular invasion (MVI), many clinicians or centers still select locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib because the survival improvement by sorafenib only is expected to be shorter than that without MVI. However this multidisciplinary approach may increase treatment related toxicity such as liver failure etc. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose for a small numbers (3-5 fractions) of large fraction size and is expected to new effective modality for HCC with MVI. Based on above suggestions, we herein offer our experience of a patient with perforation of radiation induced gastric ulcer after complete remission of tumor and main portal vein thrombosis by combination therapy of SBRT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage HCC patients with main portal vein invasion.

Citations

Citations to this article as recorded by  
  • Novel management of expected post-radiotherapy complications in hepatocellular carcinoma patients: a case report
    Sung Hoon Chang, Tae Suk Kim, Yong Hwan Jeon, Nuri Hyun Jung, Dae Hee Choi
    Journal of Liver Cancer.2022; 22(2): 183.     CrossRef
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JLC : Journal of Liver Cancer