Table of Content

31 December 2022, Volume 9 Issue 4

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Review of experts

Progresses for stereotactic radiotherapy in primary liver cancer

Zeng Zhaochong^*

2022, 9(4):  12-14. 

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In the past decade with the popularization of image guide radiotherapy, stereotactic radiotherapy (SRT) of primary liver cancer has been widely used and gained a lot of clinical experience. A gratifying course of development includes the experience from case reports or unique center retrospective clinical study to multiple center prospective clinical studies. The evidence based medicine of SRT gradually upgraded. Previous reports about SRT for patients with primary liver cancer focused on those with recurrence or metastatic disease or refractoriness which are poor prognosis in comparison with those with initial therapy with SRT. Study on the patients with primary liver cancer treated with SRT or surgical resection for intrahepatic lesions in the same period, the results showed that similar overall survival and local control rates after propensity score matching in the 2 groups. However, the toxicity is milder in the patients treated with SRT in comparison with surgical resection. Relapse or metastatic primary liver cancer is easy to recur or metastasize, so it is necessary to treat those patients using combination with both SRT and anti-programmed death-1 (PD-1) antibody. The primary results showed that SRT combination with immunotherapy has much better overall survival and progress free survival. The results indicate that it is worthy of further exploration in the future.

Special topic

Radiation therapy for hepatocellular carcinoma combined with systemic therapy

Li Changying, Xu Xin, Deng Min^*

2022, 9(4):  15-19. 

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Hepatocellular carcinoma (HCC) is the leading cause of cancer death in the world and one of the most common malignant tumors in China. At present, a small percentage of patients with early-stage disease is mostly treated by surgery. However, most patients are in the middle and late stage when diagnosed, and lose the opportunity of surgery. With the progress of radiotherapy methods and the discovery of therapeutic targets, the comprehensive treatment of HCC using radiotherapy combined with systemic therapy has rapidly increased, which are also popularized in clinical practice. In order to explore effective radiotherapy combined with systemic therapy and improve the condition and prognosis of patients with HCC, this review will systematically introduce the research progress of radiotherapy combined with systemic therapy for HCC.

Development and evidence of perioperative radiotherapy for hepatocellular carcinoma

Li Lijuan, Dong Dezuo, Wang Hongzhi, Zhu Xianggao, Wang Weihu^*

2022, 9(4):  20-25. 

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Hepatocellular carcinoma (HCC) is the main type of primary liver cancer with high incidence and poor prognosis. The long-term benefit of patients can be maximized by orderly multidisciplinary comprehensive treatment. Surgery is one of the main treatment methods for HCC, but it faces high risk of postoperative recurrence. With the development of radiotherapy technology, radiotherapy has been widely used in the treatment of HCC. The combined application of surgery and radiotherapy can effectively reduce disease recurrence and prolong patient survival. Evidence from perioperative radiotherapy for HCC shows that: for narrow-margin surgery and microvascular invasion, postoperative or intraoperative radiotherapy can make up for the insufficiency of surgery and achieve similar efficacy as wide-margin surgery; for resectable HCC with portal vein tumor thrombus, neoadjuvant radiotherapy combined with surgical resection or postoperative radiotherapy can significantly improve the prognosis; while waiting for liver transplantation, stereotactic body radiotherapy as bridging therapy can safely and effectively delay tumor progression and prevent drop-out from the waitlist. Prospective research on multidisciplinary treatment modality including radiotherapy will continue to improve the survival rate for patients with HCC.

Stereotactic radiotherapy for liver oligometastatic disease from colorectal cancer

Lei Junqin, Jin Jing

2022, 9(4):  26-31. 

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Liver is the most common site of colorectal cancer metastasis. Patients with oligometastasis may achieve long-term survival after local ablative therapy within the context of improved systemic therapy. Stereotactic radiotherapy (SRT) can deliver radical ablative doses in a small number of fractions precisely. We will discuss the safety and efficacy of SRT for liver oligometastatic disease, compare with other local treatment modality, and how to choose patients who can real benefit from SRT. We represent target volume delineation and dose limitation standard. Finally, we discuss the development of new radiotherapy technology and possibility of SRT to combined with systemic therapy.

Efficacy and safety of particle therapy for hepatocellular carcinoma: a meta-analysis

Liu Ruifeng¹, Wang Dandan², Zhang Qiuning¹, Luo Hongtao³, Dong Meng², Wang Xiaohu^1,*

2022, 9(4):  32-45. 

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Objective:To evaluate the efficacy and safety of proton and heavy ion therapy for hepatocellular carcinoma (HCC).
Method:Medline, Embase, Web of Science, China Biology Medicine (CBM), Wanfang Database and China National Knowledge Internet (CNKI) were systematically searched from inception to July 2022. Two researchers independently screened the titles and abstracts, extracted the data, and evaluated the methodological quality of the included studies. STATA 14.0 software was used for meta-analysis.
Result:Totally 13 proton irradiation and 8 carbon ion irradiation which included 1884 patients were included in our final research. The results of meta-analysis showed that carbon ion and proton irradiation could achieve higher long-term local control (LC) rates {5-year LC rate: 90% [95%(confidence interval, CI): 86%-94%], 85% (95%CI: 80%-91%)} and long-term overall survival (OS) rates for HCC [5-year OS rate: 33% (95%CI: 23%-43%), 41% (95%CI: 32%-50%)]. The results of subgroup analysis showed that HCC patients with small tumor diameter, Child-Pugh grade A, primary treatment and single tumor could achieve better survival outcomes, and the incidence of grade 3 or higher adverse events was low.
Conclusion:Proton and heavy ion therapy offer high local control, acceptable overall survival and a low recurrence rate for HCC. However, the existing literature is of low quality and incomplete reporting, especially on toxicity. Therefore, there is a strong need for more prospective, multicenter, and high-quality studies.

Original article

Global liver cancer and gallbladder cancer incidence and mortality in 2020

Shan Tianhao¹, An Lan¹, Xu Mengyuan¹, Zeng Hongmei^1,*, Cai Jianqiang^2,*

2022, 9(4):  46-51. 

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Objective:According to the data of GLOBOCAN 2020, we compared the global and Chinese incidence and mortality of liver cancer and gallbladder cancer in 2020, to provide a scientific basis for cancer prevention and control.
Method:According to the incidence and mortality data of liver cancer and gallbladder cancer released by the International Agency for Research on Cancer in 2020, the differences among different regions, genders and ages were compared.
Result:In 2020, there were 905 677 new cases and 830 180 deaths of liver cancer globally, with age-standardized incidence and mortality rates of 9.5/100 000 and 8.7/100 000, respectively. For gallbladder cancer, the numbers of new cases and deaths were 115 949 and 84 695, respectively, with the age-standardized incidence and mortality of 1.2/100 000 and 0.84/100 000, respectively. The top five countries with highest incidence of liver cancer were Mongolia, Egypt, Laos, Cambodia and Vietnam. The top five countries with highest incidence of gallbladder cancer were Bolivia, Chile, Bangladesh, Nepal and Korea. In 2020, there were 410 038 new cases of liver cancer in China, with a standardized incidence rate of 18.2/100 000, ranking 8th among all countries. There were 391 152 new cases of death from liver cancer in China, with an age-standardized mortality rate of 17.2/100 000. For gallbladder cancer, there were 28 923 new cases of incidence in China, with an age-standardized incidence rate of 1.2/100 000, ranking 39th among all countries. There were 23 297 new cases of death from gallbladder cancer in China, with an age-standardized mortality rate of 0.97/100 000.
Conclusion:The disease burden of liver cancer and gallbladder cancer is different between countries. Different prevention and control strategies should be formulated according to different populations.

Efficacy and safety of sequential transcatheter arterial chemoembolization with ¹²⁵I seed strip combined with portal vein stent implantation guided by double guidance technology in the treatment of primary hepatocellular carcinoma complicated with portal vein tumor thrombus

Zhou Tengchao^*, Tian Zhuangbo, Long Lin

2022, 9(4):  52-58. 

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Objective:To study and observe the efficacy and safety of sequential transcatheter arterial chemoembolization (TACE) with ¹²⁵I seed bar combined with portal vein stent implantation under the guidance of double guidance technology in the treatment of primary hepatocellular carcinoma (HCC) complicated with portal vein tumor thrombus (PVTT).
Method:The clinical data of 140 HCC patients with PVTT treated in Hunan Provincial People's Hospital from July 2016 to July 2018 were retrospectively analyzed. According to the treatment methods, they were divided into 60 cases in the combined group (¹²⁵I particle strip combined with portal vein stent implantation sequential TACE treatment under the guidance of double guidance technology) and 80 cases in the simple group (TACE treatment alone). The short-term efficacy and survival of the two groups, the changes of tumor thrombus size before and after treatment were observed and compared changes of liver function and laboratory indexes.
Result:①Thirty days after operation, the remission rate of the combined group was 80.0%, and the total effective rate was 96.7%. The remission rate of the simple group was 58.8%, and the total effective rate was 85.0%. The remission rate and total effective rate of the combined group were significantly higher than those of the simple group (P<0.05). ②The area of tumor thrombus after operation was significantly smaller than that before operation in both groups (P<0.05); The area of postoperative tumor thrombus in the combined group was significantly smaller than that in the simple group (P<0.05). ③ The levels of glutamic-pyruvic transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), total bilirubin (TBIL) in the two groups were significantly higher 7 days after operation than those before operation, and were significantly lower than those 30 days after operation. The analysis of variance within the two groups was statistically significant (P<0.05). The levels of GPT, GOT and TBIL in the combined group were significantly higher than those in the simple group 7 days after operation, and the levels of GPT, GOT and TBIL in the combined group 30 days after operation were significantly lower than those in the simple group, with statistical significance (P<0.05). ④The 3-year overall survival rate was 51.7% in the combined group and 23.8% in the simple group. The survival outcome of the combined group was significantly better than that of the simple group (P<0.05).
Conclusion:The short-term effect of sequential TACE guided by double guidance technology with ¹²⁵I particle strip combined with portal vein stent implantation in the treatment of HCC complicated with PVTT is better than that of TACE alone, which significantly increases the survival rate within 3 years, but the liver function injury caused by TACE should be prevented and treated in the process of treatment.