Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma: An Expert Consensus

医学 离格 肝细胞癌 放射治疗 医学物理学 外照射放疗 肿瘤科 核医学 放射科 近距离放射治疗 内科学
作者
Ted K. Yanagihara,Joel E. Tepper,Andrew M. Moon,Aisling Barry,Meritxell Mollà,Jinsil Seong,Ferrán Torres,Smith Apisarnthanarax,Michael Buckstein,Higinia R. Cárdenes,Daniel T. Chang,Mary Feng,Chandan Guha,Christopher L. Hallemeier,M. Hawkins,Morten Høyer,Hiromitsu Iwata,Salma K. Jabbour,Lisa A. Kachnic,Jordan Kharofa,Tae Hyun Kim,Alexander Kirichenko,Eugene J. Koay,Hirokazu Makishima,Joel Mases,Jeffrey Meyer,Pablo Muñoz-Schuffenegger,Dawn Owen,Hee Chul Park,Jordi Sáez,Nina N. Sanford,Marta Scorsetti,Grace L. Smith,Jennifer Y. Wo,Sang Min Yoon,Theodore S. Lawrence,María Reig,Laura A. Dawson
出处
期刊:Practical radiation oncology [Elsevier BV]
卷期号:14 (2): 134-145 被引量:1
标识
DOI:10.1016/j.prro.2023.08.016
摘要

Purpose

External beam radiation therapy (EBRT) is a highly effective treatment in select patients with hepatocellular carcinoma (HCC). However, the Barcelona Clinic Liver Cancer system does not recommend the use of EBRT in HCC due to a lack of sufficient evidence and intends to perform an individual patient level meta-analysis of ablative EBRT in this population. However, there are many types of EBRT described in the literature with no formal definition of what constitutes "ablative." Thus, we convened a group of international experts to provide consensus on the parameters that define ablative EBRT in HCC.

Methods and Materials

Fundamental parameters related to dose, fractionation, radiobiology, target identification, and delivery technique were identified by a steering committee to generate 7 Key Criteria (KC) that would define ablative EBRT for HCC. Using a modified Delphi (mDelphi) method, experts in the use of EBRT in the treatment of HCC were surveyed. Respondents were given 30 days to respond in round 1 of the mDelphi and 14 days to respond in round 2. A threshold of ≥70% was used to define consensus for answers to each KC.

Results

Of 40 invitations extended, 35 (88%) returned responses. In the first round, 3 of 7 KC reached consensus. In the second round, 100% returned responses and consensus was reached in 3 of the remaining 4 KC. The distribution of answers for one KC, which queried the a/b ratio of HCC, was such that consensus was not achieved. Based on this analysis, ablative EBRT for HCC was defined as a BED10 ≥80 Gy with daily imaging and multiphasic contrast used for target delineation. Treatment breaks (eg, for adaptive EBRT) are allowed, but the total treatment time should be ≤6 weeks. Equivalent dose when treating with protons should use a conversion factor of 1.1, but there is no single conversion factor for carbon ions.

Conclusions

Using a mDelphi method assessing expert opinion, we provide the first consensus definition of ablative EBRT for HCC. Empirical data are required to define the a/b of HCC.
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