ASTRO Guidelines for EBRT in Liver Cancer: Key Takeaways
the American Society of Radiation Oncology (ASTRO) has published a new guideline regarding external radiation therapy (EBRT) for primary liver cancer. This is ASTRO’s first recommendation for primary liver cancers, and it was published in Practical Radiation Oncology.
Recommendations for EBRT in liver cancer:
- The EBRT is strongly recommended like:
- a potential first-line treatment for hepatocellular carcinoma (HCC) confined to the liver in patients ineligible for curative therapy
- consolidation therapy after an incomplete response to previous therapies directed to the liver
- a salvage option for local recurrence.
- The EBRT is conditionally recommended:
- for patients with liver-confined or unresectable multifocal HCC
- for patients with macrovascular invasion, in sequence with systemic or catheter-based therapies
- as palliative treatment for symptomatic primary HCC and/or macrovascular tumor thrombi
- as a transition to transplantation or before surgery in selected patients
- as adjuvant therapy for resected intrahepatic cholangiocarcinoma (IHC) with high-risk features
The task force suggested that consolidation EBRT with or without chemotherapy should be considered for patients with unresectable IHC, usually after systemic therapy. “Selection of dose-splitting regimen and technique should be based on extent of disease, location of disease, underlying liver function, and available technologies,” the task force added. .
In addition to these recommendations, the guideline also includes treatment algorithms for unresectable and resectable IHC, and addresses issues such as optimal dosage, fractionation, treatment planning, and administration techniques for EBRT. .
Learn more about the ASTRO Directive
ASTRO assembled a working group to create these guidelines based on a systematic review of the literature literally from January 2000 to February 2020. The working group included members from multiple disciplines including radiation therapy, medical and surgical oncology, medical physics, hepatology and transplant surgery. ASTRO has collaborated on this guideline with the American Society of Clinical Oncology, American Society of Transplant Surgeons, and Society of Surgical Oncology.
“We believe this guideline is an important step in the management of primary liver cancers, as we hope to provide practitioners and the public with a systematic, evidence-based basis of where EBRT might fit into the overall complex picture of dealing with these difficult cases. ,” noted Smith Apisarnthanarax, MD, vice chair of the guidelines task force, medical director of the Seattle Cancer Care Alliance and professor of radiation oncology at the University of Washington, in a Press release.
Learn more about liver cancer
Primary liver cancers are the fourth leading cause of cancer death worldwide, with incidence rates more than tripling in the United States since 1980. HCC and IHC mortality rates continue to rise. Common treatments for primary HCC include liver transplantation, tumor resection, thermal ablation and catheter therapies for cancers confined to the liver, and systemic therapy (targeted therapy and/or immunotherapy). For IHC, the standard treatment includes a combination of surgery and chemotherapy, with or without radiation therapy.
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What is EBRT?
EBRT is a type of radiation therapy that targets high doses of targeted radiation at tumor sites outside the body. This treatment has historically been used less frequently than other approaches for liver cancers.
“Historically, low rates of external radiation use were due to technological limitations that made it difficult to avoid healthy liver tissue.” noted Higinia Cardenes, MD, Ph.D., chair of the guidelines working group and professor of clinical radiation oncology at Weill Cornell Medicine. “However, thanks to significant advances in imaging and radiotherapy over the past 15 years and a better understanding of how the liver responds to radiation, we now have a growing amount of clinical data on the role that EBRT can play for patients with these diseases.”
RELATED: ASTRO: Underutilized EBRT in Liver Cancer Patients Awaiting Transplant