Underutilized external beam radiation therapy for people with liver cancer waiting for a transplant

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Newswise – ARLINGTON, Virginia, October 24, 2021 – People with liver cancer waiting for a transplant may benefit from non-invasive radiation therapy, but rarely receive this therapy, according to a new analysis of U.S. national data. The results will be presented today at the annual meeting of the American Society for Radiation Oncology (ASTRO).

“External beam radiation therapy is a proven, established, safe and effective treatment option for patients with unresectable liver cancer, but its underuse in this population (less than 4% of patients) is highlight a real gap in the treatment options available. for patients with hepatocellular carcinoma, ”said study author Nima Nabavizadeh, MD, associate professor of radiation oncology and director of the residency program at Oregon Health & Science University in Portland.

Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the fourth leading cause of cancer death. About 90% of patients with HCC also have cirrhosis, which occurs when an underlying liver disease causes scarring and permanent liver damage and is the most important risk factor for liver cancer. People with unresectable HCC have tumors in the liver that cannot be safely removed with surgery, due to the severity of the underlying cirrhosis or other clinical factors.

For patients with localized liver cancer and advanced cirrhosis, “liver transplantation is the best and only chance for long-term survival,” said Dr Nabavizadeh. However, the supply of organs available for transplantation is limited and applicants often wait months or more than a year to obtain a new liver. Also, if a patient’s cancer spreads outside of transplant size criteria or to another part of the body while they are waiting for a new liver, they are no longer eligible for a transplant. Many patients therefore receive liver-directed transition therapy, which is treatment to prevent the growth or spread of tumors during the waiting period.

Liver-focused treatment options for patients awaiting transplantation include: (1) thermal ablation procedures, which use advanced imaging technology to guide the probes through the skin and into the liver, to burn or freeze tumors at the site; catheter treatments, including (2) transarterial chemoembolization (TACE) and (3) Y-90 radioembolization, where small particles are selectively injected into an artery directly supplying the tumor that cuts off the blood supply to the tumor. tumor and trap chemotherapy drugs or radioactive substances inside the tumor and (4) external beam radiation therapy (EBRT), which targets high doses of targeted radiation at tumor sites outside the body using non-invasive techniques.

Dr Nabavizadeh and his team analyzed data from the United Network for Organ Sharing (UNOS), a non-profit organization that operates the US transplant system under contract with the federal government, to see which bridging therapies were prescribed most often. Of the 18,477 patients with HCC waiting for a transplant since 2013, 85.4% received some type of bridging therapy. However, only 3.6% of these patients were treated with EBRT, either alone (1.2%) or in combination with another type of therapy (2.4%).

Dr Nabavizadeh said he expected the number to be much higher. “Using our own institutional experience, over 4% of our patients get EBRT at some point, so 3.6% was a surprising number for us,” he said, “mostly because radiation therapy is the only non-invasive option and has not been shown to be inferior to other treatments.

The analysis also found that the use of EBRT has increased in recent years, but remains much lower than the use for other therapies. TACE was the most used therapy, used for 39.6% of patients. Thermal ablation was used for 12.8% of patients and radioembolization was used for 8.7% of patients. Almost a quarter of patients (22.2%) received a combination of non-EBRT therapies.

Because there is no data supporting one treatment over another, said Dr Nabavizadeh, institutional and regional practice patterns are often the key factor in treatment decisions. Indeed, the use of EBRT varied by geographic region, ranging from a maximum of 8.7% of patients in the Great Lakes states (Michigan, Ohio and Indiana) receiving this type of bridging therapy to one. minimum of 1.7% of patients in the Southeast (Florida, Georgia, Mississippi, Alabama, Louisiana, Arkansas) (p

While the study did not explore why patients were prescribed one treatment over another, Dr Nabavizadeh suggested that it could be a result of the type of doctor a patient saw. “Radiation oncologists are often excluded from discussions about the management of these patients,” he said. “When presented with choices, many patients want a non-invasive approach. They understand that this treatment could really have an impact on their quality of life. Radiation therapy needs to be a part of treatment discussions much more frequently than it is now. “

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Attribution to the American Society for Radiation Oncology (ASTRO) Annual Meeting is required in all covers.

See this study presented:

  • Graft Bridge External Beam Radiation Therapy in Patients with Hepatocellular Carcinoma: Analysis of the Use of the United Network for Organ Sharing (UNOS) Database (Summary 2078) (summary and disclosures included below)
  • Press point: Monday, October 25, 2 p.m. central time. Details here.
  • Scientific presentation: Sunday, October 24, 1:30 p.m. CST, McCormick Place West, room W375. Details here; E-mail [email protected] for access.

ABOUT ASTRO

The American Society for Radiation Oncology (ASTRO) is the world’s largest radiation oncology society, with nearly 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists, and other health professionals who specialize in treating patients with radiotherapy. . For more information on radiation therapy, visit RTAnswers.org. To learn more about ASTRO, visit our website and follow us on social media.


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