TY - JOUR
T1 - Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma
T2 - An Expert Consensus
AU - Yanagihara, Ted K.
AU - Tepper, Joel E.
AU - Moon, Andrew M.
AU - Barry, Aisling
AU - Molla, Meritxell
AU - Seong, Jinsil
AU - Torres, Ferran
AU - Apisarnthanarax, Smith
AU - Buckstein, Michael
AU - Cardenes, Higinia
AU - Chang, Daniel T.
AU - Feng, Mary
AU - Guha, Chandan
AU - Hallemeier, Christopher L.
AU - Hawkins, Maria A.
AU - Hoyer, Morten
AU - Iwata, Hiromitsu
AU - Jabbour, Salma K.
AU - Kachnic, Lisa
AU - Kharofa, Jordan
AU - Kim, Tae Hyun
AU - Kirichenko, Alexander
AU - Koay, Eugene J.
AU - Makishima, Hirokazu
AU - Mases, Joel
AU - Meyer, Jeffrey J.
AU - Munoz-Schuffenegger, Pablo
AU - Owen, Dawn
AU - Park, Hee Chul
AU - Saez, Jordi
AU - Sanford, Nina N.
AU - Scorsetti, Marta
AU - Smith, Grace L.
AU - Wo, Jennifer Y.
AU - Yoon, Sang Min
AU - Lawrence, Theodore S.
AU - Reig, Maria
AU - Dawson, Laura A.
N1 - Publisher Copyright:
© 2023
PY - 2024/3/1
Y1 - 2024/3/1
N2 - 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.
AB - 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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U2 - 10.1016/j.prro.2023.08.016
DO - 10.1016/j.prro.2023.08.016
M3 - Article
C2 - 38244026
AN - SCOPUS:85185493675
SN - 1879-8500
VL - 14
SP - 134
EP - 145
JO - Practical Radiation Oncology
JF - Practical Radiation Oncology
IS - 2
ER -