Radiation segmentectomy: Potential curative therapy for early hepatocellular carcinoma

Robert J Lewandowski, Ahmed Gabr, Nadine Abouchaleh, Rehan Ali, Ali Al Asadi, Ronald A. Mora, Laura M Kulik, Daniel R Ganger, Kush R Desai, Bartley Thornburg, Samdeep K Mouli, Ryan Hickey, Juan C Caicedo, Michael Messod Abecassis, Ahsun Riaz, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: To report long-term outcomes of radiation segmentectomy (RS) for early hepatocellular carcinoma (HCC). The authors hypothesized that outcomes are comparable to curative treatments for patients with solitary HCC less than or equal to 5 cm and preserved liver function. Materials and This retrospective study included 70 patients (median age, Methods: 71 years; range, 22-96 years) with solitary HCC less than or equal to 5 cm not amenable to percutaneous ablation who underwent RS (dose of .190 Gy) between 2003 and 2016. Patients who underwent subsequent curative liver transplantation were excluded to eliminate this confounding variable affecting survival. Radiologic response of time to progression and median overall survival were estimated by using the Kaplan-Meier method per the guidelines of the European Association for the Study of the Liver (EASL) and the World Health Organization (WHO). Results: Seventy patients were treated with RS over 14 years. Sixty-three patients (90%) showed response by using EASL criteria, of which 41 (59%) showed complete response. Fifty patients (71%) achieved response by using WHO criteria, of which 11 (16%) achieved complete response. Response rates at 6 months were 86% and 49% by using EASL and WHO criteria, respectively. Median time to progression was 2.4 years (95% confidence interval: 2.1, 5.7), with 72% of patients having no target lesion progression at 5 years. Median overall survival was 6.7 years (95% confidence interval: 3.1, 6.7); survival probability at 1, 3, and 5 years was 98%, 66%, and 57%, respectively. Overall survival probability at 1, 3, and 5 years was 100%, 82%, and 75%, respectively, in patients with baseline tumor size less than or equal to 3 cm (n = 45) and was significantly longer than in patients with tumors greater than 3 cm (P = .026). Conclusion: RS provides response rates, tumor control, and survival outcomes comparable to curative-intent treatments for selected patients with early-stage HCC who have preserved liver function.

Original languageEnglish (US)
Pages (from-to)1050-1058
Number of pages9
JournalRadiology
Volume287
Issue number3
DOIs
StatePublished - Jun 1 2018

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Segmental Mastectomy
Hepatocellular Carcinoma
Radiation
Survival
Therapeutics
Liver
Confidence Intervals
Neoplasms
Confounding Factors (Epidemiology)
Liver Transplantation
Reaction Time
Retrospective Studies
Guidelines

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{8f64895e9fe248d6a878ccb3f0f3972e,
title = "Radiation segmentectomy: Potential curative therapy for early hepatocellular carcinoma",
abstract = "Purpose: To report long-term outcomes of radiation segmentectomy (RS) for early hepatocellular carcinoma (HCC). The authors hypothesized that outcomes are comparable to curative treatments for patients with solitary HCC less than or equal to 5 cm and preserved liver function. Materials and This retrospective study included 70 patients (median age, Methods: 71 years; range, 22-96 years) with solitary HCC less than or equal to 5 cm not amenable to percutaneous ablation who underwent RS (dose of .190 Gy) between 2003 and 2016. Patients who underwent subsequent curative liver transplantation were excluded to eliminate this confounding variable affecting survival. Radiologic response of time to progression and median overall survival were estimated by using the Kaplan-Meier method per the guidelines of the European Association for the Study of the Liver (EASL) and the World Health Organization (WHO). Results: Seventy patients were treated with RS over 14 years. Sixty-three patients (90{\%}) showed response by using EASL criteria, of which 41 (59{\%}) showed complete response. Fifty patients (71{\%}) achieved response by using WHO criteria, of which 11 (16{\%}) achieved complete response. Response rates at 6 months were 86{\%} and 49{\%} by using EASL and WHO criteria, respectively. Median time to progression was 2.4 years (95{\%} confidence interval: 2.1, 5.7), with 72{\%} of patients having no target lesion progression at 5 years. Median overall survival was 6.7 years (95{\%} confidence interval: 3.1, 6.7); survival probability at 1, 3, and 5 years was 98{\%}, 66{\%}, and 57{\%}, respectively. Overall survival probability at 1, 3, and 5 years was 100{\%}, 82{\%}, and 75{\%}, respectively, in patients with baseline tumor size less than or equal to 3 cm (n = 45) and was significantly longer than in patients with tumors greater than 3 cm (P = .026). Conclusion: RS provides response rates, tumor control, and survival outcomes comparable to curative-intent treatments for selected patients with early-stage HCC who have preserved liver function.",
author = "Lewandowski, {Robert J} and Ahmed Gabr and Nadine Abouchaleh and Rehan Ali and {Al Asadi}, Ali and Mora, {Ronald A.} and Kulik, {Laura M} and Ganger, {Daniel R} and Desai, {Kush R} and Bartley Thornburg and Mouli, {Samdeep K} and Ryan Hickey and Caicedo, {Juan C} and Abecassis, {Michael Messod} and Ahsun Riaz and Riad Salem",
year = "2018",
month = "6",
day = "1",
doi = "10.1148/radiol.2018171768",
language = "English (US)",
volume = "287",
pages = "1050--1058",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
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}

Radiation segmentectomy : Potential curative therapy for early hepatocellular carcinoma. / Lewandowski, Robert J; Gabr, Ahmed; Abouchaleh, Nadine; Ali, Rehan; Al Asadi, Ali; Mora, Ronald A.; Kulik, Laura M; Ganger, Daniel R; Desai, Kush R; Thornburg, Bartley; Mouli, Samdeep K; Hickey, Ryan; Caicedo, Juan C; Abecassis, Michael Messod; Riaz, Ahsun; Salem, Riad.

In: Radiology, Vol. 287, No. 3, 01.06.2018, p. 1050-1058.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radiation segmentectomy

T2 - Potential curative therapy for early hepatocellular carcinoma

AU - Lewandowski, Robert J

AU - Gabr, Ahmed

AU - Abouchaleh, Nadine

AU - Ali, Rehan

AU - Al Asadi, Ali

AU - Mora, Ronald A.

AU - Kulik, Laura M

AU - Ganger, Daniel R

AU - Desai, Kush R

AU - Thornburg, Bartley

AU - Mouli, Samdeep K

AU - Hickey, Ryan

AU - Caicedo, Juan C

AU - Abecassis, Michael Messod

AU - Riaz, Ahsun

AU - Salem, Riad

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Purpose: To report long-term outcomes of radiation segmentectomy (RS) for early hepatocellular carcinoma (HCC). The authors hypothesized that outcomes are comparable to curative treatments for patients with solitary HCC less than or equal to 5 cm and preserved liver function. Materials and This retrospective study included 70 patients (median age, Methods: 71 years; range, 22-96 years) with solitary HCC less than or equal to 5 cm not amenable to percutaneous ablation who underwent RS (dose of .190 Gy) between 2003 and 2016. Patients who underwent subsequent curative liver transplantation were excluded to eliminate this confounding variable affecting survival. Radiologic response of time to progression and median overall survival were estimated by using the Kaplan-Meier method per the guidelines of the European Association for the Study of the Liver (EASL) and the World Health Organization (WHO). Results: Seventy patients were treated with RS over 14 years. Sixty-three patients (90%) showed response by using EASL criteria, of which 41 (59%) showed complete response. Fifty patients (71%) achieved response by using WHO criteria, of which 11 (16%) achieved complete response. Response rates at 6 months were 86% and 49% by using EASL and WHO criteria, respectively. Median time to progression was 2.4 years (95% confidence interval: 2.1, 5.7), with 72% of patients having no target lesion progression at 5 years. Median overall survival was 6.7 years (95% confidence interval: 3.1, 6.7); survival probability at 1, 3, and 5 years was 98%, 66%, and 57%, respectively. Overall survival probability at 1, 3, and 5 years was 100%, 82%, and 75%, respectively, in patients with baseline tumor size less than or equal to 3 cm (n = 45) and was significantly longer than in patients with tumors greater than 3 cm (P = .026). Conclusion: RS provides response rates, tumor control, and survival outcomes comparable to curative-intent treatments for selected patients with early-stage HCC who have preserved liver function.

AB - Purpose: To report long-term outcomes of radiation segmentectomy (RS) for early hepatocellular carcinoma (HCC). The authors hypothesized that outcomes are comparable to curative treatments for patients with solitary HCC less than or equal to 5 cm and preserved liver function. Materials and This retrospective study included 70 patients (median age, Methods: 71 years; range, 22-96 years) with solitary HCC less than or equal to 5 cm not amenable to percutaneous ablation who underwent RS (dose of .190 Gy) between 2003 and 2016. Patients who underwent subsequent curative liver transplantation were excluded to eliminate this confounding variable affecting survival. Radiologic response of time to progression and median overall survival were estimated by using the Kaplan-Meier method per the guidelines of the European Association for the Study of the Liver (EASL) and the World Health Organization (WHO). Results: Seventy patients were treated with RS over 14 years. Sixty-three patients (90%) showed response by using EASL criteria, of which 41 (59%) showed complete response. Fifty patients (71%) achieved response by using WHO criteria, of which 11 (16%) achieved complete response. Response rates at 6 months were 86% and 49% by using EASL and WHO criteria, respectively. Median time to progression was 2.4 years (95% confidence interval: 2.1, 5.7), with 72% of patients having no target lesion progression at 5 years. Median overall survival was 6.7 years (95% confidence interval: 3.1, 6.7); survival probability at 1, 3, and 5 years was 98%, 66%, and 57%, respectively. Overall survival probability at 1, 3, and 5 years was 100%, 82%, and 75%, respectively, in patients with baseline tumor size less than or equal to 3 cm (n = 45) and was significantly longer than in patients with tumors greater than 3 cm (P = .026). Conclusion: RS provides response rates, tumor control, and survival outcomes comparable to curative-intent treatments for selected patients with early-stage HCC who have preserved liver function.

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U2 - 10.1148/radiol.2018171768

DO - 10.1148/radiol.2018171768

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AN - SCOPUS:85050435403

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JF - Radiology

SN - 0033-8419

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