scholarly journals Association between Time to Local Tumor Control and Treatment Outcomes Following Repeated Loco-Regional Treatment Session in Patients with Hepatocellular Carcinoma: A RETROSPECTIVE, Single-Center Study

Life ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1062
Author(s):  
Krzysztof Bartnik ◽  
Wacław Hołówko ◽  
Olgierd Rowiński
Keyword(s):  
Hepatocellular Carcinoma ◽  
Treatment Outcomes ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Local Tumor Control ◽  
Primary Study ◽  
Tumor Control ◽  
Local Tumor ◽  
Regional Treatment

Background: Whether the number of loco-regional treatment sessions and the time required to obtain local tumor control (LTC) affects the prognosis of patients with hepatocellular carcinoma (HCC) remains controversial. This study aimed to determine whether a longer time to LTC is a significant and independent predictor of poor treatment outcomes. Methods: In this retrospective study, we analyzed data of 139 treatment-naive patients with HCC who were not eligible for a treatment other than transarterial chemoembolization (TACE) at baseline. The outcome analyses were performed using the Cox proportional hazard model and Kaplan–Meier method, while the overall survival (OS) and progression free survival (PFS) were the primary study endpoints. Results: Overall, LTC was achieved in 82 (59%) of patients, including 67 (81%) patients who achieved LTC following TACE sessions alone and 15 (19%) subjects required additional ablation session. The median OS did not differ significantly between groups that needed 2, 3, or >3 locoregional treatment sessions to achieve LTC (p = 0.37). Longer time to LTC (in weeks) was significantly associated with shorter OS in univariate analysis (p = 0.04), but not in an adjusted model (p = 0.14). Both univariate and adjusted analyses showed that longer time to reach LTC was significantly associated with shorter PFS (adjusted HR = 1.04, 95% CI 1.001–1.09, p = 0.048). Conclusions: These findings show that the longer time to LTC is not an independent predictor of OS, but suggest that PFS may be significantly shorter in patients with longer time to LTC.

scholarly journals Nervous System Hemangiopericytoma

2019 ◽  
Vol 47 (1) ◽  
pp. 18-29 ◽  
Author(s):  
Or Cohen-Inbar
Keyword(s):  
Nervous System ◽  
Tumor Volume ◽  
External Beam Radiotherapy ◽  
Progression Free Survival ◽  
Mass Effect ◽  
Local Tumor Control ◽  
Volume Control ◽  
Tumor Control ◽  
Local Tumor ◽  
Hybrid Surgery

Abstract:The management of patients harboring central nervous system (CNS) hemangiopericytomas (HPCs) is a partially answered challenge. These are rare locally aggressive lesions, with potential for local recurrence, distal neural metastasis (DNM), and extraneural metastasis (ENM). Resection, when feasible, remains the initial treatment option, providing histological diagnosis and immediate relief of tumor-related mass effect. Patients receiving surgery alone or surgery and external beam radiotherapy (EBRT) show improved overall survival (OS) and progression-free survival as compared to those undergoing a biopsy alone (p = 0.01 and p = 0.02, respectively). Yet, in many instances, patient and tumor-related parameters preclude complete resection. EBRT or stereotactic radiosurgery (SRS) shares a significant role in achieving local tumor control, not shown to impact OS in HPC patients. The benefits of SRS/EBRT are clearly limited to improved local tumor volume control and neurologic function, not affecting DNM or ENM development. SRS provides acceptable rates of local tumor volume control coupled with treatment safety and a patient-friendly apparatus and procedure. Single-session SRS is most effective for lesions measuring <2 cm in their largest diameter (10 cm3 volume), with prescription doses of at >15 Gy. Systemic HPC disease is managed with various chemotherapeutic, immunotherapeutic, and anti-angiographic agents, with limited success. We present a short discussion on CNS HPCs, focusing our discussion on available evidence regarding the role of microsurgical resection, EBRT, SRS, chemotherapy, and immunotherapy for upfront, part of adoptive hybrid surgery approach or for recurrent HPCs.

scholarly journals STMO-17 Treatment outcome of photodynamic therapy using talaporfin sodium for recurrent high-grade glioma

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi14-vi14
Author(s):  
Makoto Ohno ◽  
Daisuke Kawauchi ◽  
Yoshiharu Hayashi ◽  
Kaishi Satomi ◽  
Yasuji Miyakita ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Treatment Outcome ◽  
Treatment Outcomes ◽  
High Grade Glioma ◽  
Local Tumor Control ◽  
Tumor Control ◽  
High Grade ◽  
Local Tumor ◽  
Limit Of Quantification ◽  
Talaporfin Sodium

Abstract Objective: Photodynamic therapy (PDT) using Talaporfin Sodium (TS) is a novel therapeutic strategy to improve local tumor control in high-grade glioma. TS is a photosensitizer that accumulates in tumor cells and produces highly toxic free radicals by intraoperative irradiation of laser with a 664nm wavelength. However, little is known about the treatment outcomes of PDT in recurrent high-grade gliomas (rHGG). In this study, we investigated the treatment outcome of PDT in rHGG and evaluated the correlation between intratumoral TS accumulation and outcomes. Methods: We included 21 patients with rHGG and 22 tumors, who were treated by PDT between June 2016 and March 2021. TS was transvenously administered 22–26 hours before PDT. Intratumoral TS concentrations were measured by liquid chromatography using frozen tissue. Results: The rHGGs included 10 glioblastoma, IDH1/2-wildtype (GBM, IDH1/2-WT: 45.5%), 3 GBM, IDH1/2-mutant (GBM, IDH1/2-Mut: 13.6%), 7 anaplastic oligodendroglioma, IDH1/2-Mut/codel (AO, IDH1/2-Mut/codel: 31.8%), 1 anaplastic astrocytoma, IDH1/2-WT (AA, IDH1/2-WT: 4.5%), 1 high-grade astrocytoma, IDH1/2-WT (4.5%). The median local progression free survival (PFS) time after PDT was 3.6 months and the median survival time from PDT was 19.4 months. The intratumoral TS concentrations of 7 tumors (TS(-): 31.8%) were below the limit of quantification, and the intratumoral TS concentrations of the remaining 15 tumors (TS(+)) were 43.5 ng/mg-protein (14.7–132 ng/mg-protein). The intratumoral TS concentrations were not significantly associated with IDH1/2 mutation status, cellularity, tumor grade, and pattern of enhancement. The median PFS from PDT tended to be longer in TS(+) than in TS(-) (TS(+): 6.3 vs TS(-): 1.4 months, p = 0.054). Conclusions: We found that the intratumoral TS concentrations were heterogeneous and 31.8% were below the limit of quantification. TS(+) tended to have better local tumor control than TS(-), suggesting the intratumoral TS accumulation have an impact of treatment outcomes of PDT.

scholarly journals Laparoscopic Liver Resection versus Percutaneous Radiofrequency Ablation for Small Single Nodular Hepatocellular Carcinoma: Comparison of Treatment Outcomes

Liver Cancer ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 25-37
Author(s):  
Dong Ho Lee ◽  
Jing Woong Kim ◽  
Jeong Min Lee ◽  
Jong Man Kim ◽  
Min Woo Lee ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Treatment Outcomes ◽  
Cumulative Incidence ◽  
Laparoscopic Liver Resection ◽  
Local Tumor Control ◽  
Treatment Modalities ◽  
Tumor Control ◽  
Percutaneous Radiofrequency Ablation ◽  
Local Tumor

<b><i>Background:</i></b> Treatment outcomes of laparoscopic liver resection (LLR) and percutaneous radiofrequency ablation (p-RFA) for small single hepatocellular carcinomas (HCCs) have not yet been fully compared. The aim of this study was to compare LLR and p-RFA as first-line treatment options in patients with single nodular HCCs ≤3 cm. <b><i>Methods:</i></b> From January 2014 to December 2016, a total of 566 patients with single nodular HCC ≤3 cm treated by either LLR (<i>n</i> = 251) or p-RFA (<i>n</i> = 315) were included. The recurrence-free survival (RFS) and cumulative incidence of local tumor progression (LTP) were estimated using Kaplan-Meier methods and compared using the log-rank test. Treatment outcome of 2 treatment modalities was compared in the subgroup of patients according to the tumor location. <b><i>Results:</i></b> There were no significant differences in overall survival between LLR and p-RFA (<i>p</i> = 0.160); however, 3-year RFS was demonstrated to be significantly higher after LLR (74.4%) than after p-RFA (66.0%) (<i>p</i> = 0.013), owing to its significantly lower cumulative incidence of LTP (2.1% at 3 years after LLR vs. 10.0% after p-RFA, <i>p</i> &#x3c; 0.001). The complication rate of p-RFA was significantly lower than that of LLR (5.1 vs. 10.0%, <i>p</i> = 0.026). LLR also provided significantly better local tumor control than p-RFA for subscapular tumors (3-year LTP rates: 1.9 vs. 8.8%, <i>p</i> = 0.012), perivascular tumors (3-year LTP rates: 0.0 vs. 17.2%, <i>p</i> = 0.007), and tumors located in anteroinfero-lateral liver portions (3-year LTP rates: 0.0 vs. 10.7%, <i>p</i> &#x3c; 0.001). However, there were no significant differences in LTP rates between LLR and p-RFA for non-subcapsular and non-perivascular tumors (<i>p</i> = 0.482) and for tumors in postero-superior liver portions (<i>p</i> = 0.380). <b><i>Conclusions:</i></b> LLR can provide significantly better local tumor control than p-RFA for small single HCCs in subcapsular, perivascular, and anteroinferolateral liver portions and thus may be the preferred treatment option for these tumors.

scholarly journals Gamma Knife surgery for treating brain metastases arising from hepatocellular carcinomas

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 102-109 ◽  
Author(s):  
Eun Suk Park ◽  
Do Hoon Kwon ◽  
Jun Bum Park ◽  
Do Hee Lee ◽  
Young Hyun Cho ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Univariate Analysis ◽  
Radiation Therapy Oncology Group ◽  
Local Tumor Control ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Significant Variable ◽  
Local Tumor ◽  
The Mean

ObjectBrain metastases from hepatocellular carcinoma (HCC) are rare, and the evidence of the effectiveness of Gamma Knife surgery (GKS) in this disease is lacking. The authors report their institutional experience with GKS in patients with brain metastases from HCCs.MethodsThe authors retrospectively reviewed the medical records of 73 consecutive patients who had a combined total of 141 brain metastases arising from HCCs and were treated with GKS. Sixty-four (87.7%) patients were male, and the mean age of the patients was 52.5 years (range 30–79 years). The mean tumor volume was 7.35 cm3 (range 0.19–33.7 cm3). The median margin dose prescribed was 23 Gy (range 15–32 Gy). Univariate and multivariate survival analyses were performed to identify possible prognostic factors of outcomes.ResultsThe estimated rate of local tumor control was 79.6% at 3 months after GKS. The median overall survival time after GKS was 16 weeks. The actuarial survival rates were 76.7%, 58.9%, and 26.0% at 4, 12, and 24 weeks after GKS, respectively. In the univariate analysis, an age of ≤ 65 years, Child-Pugh Class A (pertaining to liver function), high Karnofsky Performance Scale score (≥ 70), and low Radiation Therapy Oncology Group recursive partitioning analysis class (I or II) were positively associated with the survival times of patients. No statistically significant variable was identified in the multivariate analysis.ConclusionsAlthough survival was extremely poor in patients with brain metastases from HCCs, GKS showed acceptable local tumor control at 3 months after the treatment. The authors suggest that GKS represents a noninvasive approach that may provide a valuable option for treating patients with brain metastases from HCCs.

Low-grade gliomas treated by fractionated gamma knife surgery

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 19-24 ◽  
Author(s):  
Gabriela Simonová ◽  
Josef Novotny ◽  
Roman Liscák
Keyword(s):  
Gamma Knife ◽  
Progression Free Survival ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Low Grade ◽  
Local Tumor ◽  
Free Survival ◽  
Content Type ◽  
Low Grade Gliomas ◽  
Fine Print

Object. The authors sought to evaluate local tumor control, complications, and progression-free survival in patients harboring low-grade gliomas who were treated with Leksell gamma knife surgery (GKS). Methods. During a 6-year period 70 patients were treated for verified low-grade gliomas (Grade I or II) by GKS. Statistical analysis was based on 68 patients; two patients were lost to follow up. The median patient age was 17 years. The median target volume was 4200 mm.3 The median prescription dose was 25 Gy. The median number of fractions was five. Ninety-five percent of patients were treated in five daily fractions. Partial or complete tumor regression was achieved in 83% of patients with a median time to response of 18 months. There was moderate acute or late toxicity in not more than 5% of patients. In this series the progression-free survival was 92% at 3 years and 88% at 5 years. Conclusions. Relatively high local tumor control with minimal complications was achieved.

scholarly journals Stereotactic Body Radiotherapy as a Salvage Therapy after Incomplete Radiofrequency Ablation for Hepatocellular Carcinoma: A Retrospective Cohort Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Yizhen Fu ◽  
Mian Xi ◽  
Yangxun Pan ◽  
Jinbin Chen ◽  
Juncheng Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Salvage Therapy ◽  
Stereotactic Body Radiotherapy ◽  
Objective Response ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Grade 3

Residual tumor tissue after radiofrequency ablation (RFA) is inevitable in clinical practice, and the optimal management of residual tumor after RFA has not been established. To evaluate the efficiency and toxicity of stereotactic body radiotherapy (SBRT) as a salvage therapy after incomplete RFA for hepatocellular carcinoma (HCC), we retrospectively included 32 HCC patients with an initial incomplete response (iIR) to RFA from May 2011 to August 2018. An iIR was defined as the presence of residual enhancement on CT or MRI one month after RFA treatment. The primary endpoint was local tumor control (LTC); the secondary endpoints included progression-free survival (PFS), overall survival (OS), and toxicity. All patients fulfilled 6 fractions of SBRT as planned, with dosages ranging from 30 Gy to 54 Gy. The objective response rate (ORR) was 50.0%. The 1- and 2-year LTC rates were 86.6% (95% CI, 74.3% to 98.9%) and 74.7% (95% CI, 55.9% to 93.5%), respectively. Fewer times of prior treatments was associated with better LTC (HR = 11.7, P=0.026). The 1- and 2-year PFS rate were 69.9% (95% CI, 53.4% to 86.4%) and 52.7% (95% CI, 33.1% to 72.3%), respectively. A higher Child-Pugh score was the only independent risk factor for tumor progression (HR = 5.17, P=0.012). The 1- and 3-year OS rate were 85.6% and 67.1%, respectively. Only two patients suffered grade 3 adverse events, and none experienced grade 4 or 5 events. In conclusion, for HCC patients confirmed to have an iIR to prior RFA, with compensated liver function, SBRT provided favorable LTC and OS along with acceptable toxicity.

Sign in / Sign up

Export Citation Format

Share Document