Beau Bosko Toskich: RS or EBRT as initial treatment for Solitary Hepatocellular Carcinoma
Beau Bosko Toskich, Professor of Radiology and Director of Interventional Oncology at Mayo Clinic Florida, shared a post on X about a paper he co-authored with colleagues published in Journal of Hepatocellular Carcinoma:
“We report our multicenter experience in using either Y90 Radiation Segmentectomy (RS) or Ablative External Beam Radiation Therapy (EBRT) as initial treatment for Solitary Hepatocellular Carcinoma.
Purpose
Prospective data evaluating RS and EBRT has been challenging to obtain.
Patients
Solitary, treatment naïve, HCC ≤ 8 cm.
86 patients (RS [100% glass]: 58; EBRT [43% proton]: 28).
EBRT treated older patients (median 76 vs 66 years, p < 0.001), larger tumors (median 3.7 vs 2.4 cm, p < 0.001), and higher ECOG (p = 0.02).
RS treated more patients with ≥ grade 3 fibrosis (p < 0.001) and subsequent liver transplant (48% compared to 11%).
These disparities prevented a significant matched comparison.
Treatment
RS = median 638 Gy single compartment MIRD, SA 703 Bq, PD 18,200/cc.
EBRT = 50 Gy (range: 39–67.5) and BED 100 Gy (range: 84–100). SBRT 71% (5 fractions), 29% received 15 fractions.
Outcomes
Censored for liver transplant.
mRECIST CR achieved in 97% of RS and 82% of EBRT patients (p = 0.02).
Median time to CR was 1 month (95% CI: 0.9–1.1) after RS and 7 months (95% CI: 6–7) after EBRT (p < 0.001).
Targeted tumor complete pathologic necrosis in liver transplant patients: RS = 76% and EBRT = 33%.
1-year LC was 97% (RS) and 93% (EBRT) (p = 0.80).
1-year PFS was 87% (RS) and 80% (EBRT) (p = 0.26).
1- and 2-year OS was 88% and 85% (RS) vs 84% and 59% (EBRT) (p = 0.34).
Conclusion
RS and EBRT are effective for solitary HCC, but used in different patients. Treatment should be determined via multidisciplinary discussion.”
Authors: Cynthia De la Garza-Ramos, S Ali Montazeri, Jordan LeGout, Andrew Lewis, Gregory Frey, Ricardo Paz-Fumagalli, Christopher Hallemeier, Michael Rutenberg, Jonathan Ashman, Beau Bosko Toskich.
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