August 14, 2017

JAMA Oncology- New treatment paradigm for hepatocellular cancers

99% local control and low complication rate achieved at one year (95% at 2 yrs) with individualized radiation therapy Phase II clinical trial

Standard radiation therapy relies on population-based toxicity estimates which limit the intensity of therapy for 95% of patients based on the risk of toxicity to the most sensitive 5%. We designed a trial for patients with hepatocellular cancers to test the hypothesis that adapting treatment for the individual patient based on the change in liver function during the course of treatment could optimize the therapeutic index for each patient. In our large Phase II clinical trial (90 patients), we found that treatment was well tolerated with a lower complication rate than expected without adaptation. One-year and two-year local control was 99% and 95%, respectively. We have also used an adaptive approach in lung cancer with equally promising results (1). Taken together, our findings suggest that individualized adaptive radiotherapy may represent a new treatment paradigm for radiation oncology in which dose is based on individual, rather than population-based, response to treatment.

  1. Kong F, Ten Haken RK, Schipper M, Frey KA, Hayman J, Gross M, Ramnath N, Hassan KA, Matuszak M, Ritter T, Bi N, Wang W, Orringer M, Cease KB, Lawrence TS, Kalemkerian GP. Effect of Midtreatment PET/CT-Adapted Radiation Therapy With Concurrent Chemotherapy in Patients With Locally Advanced Non–Small-Cell Lung Cancer A Phase 2 Clinical Trial. JAMA Oncol. Published online June 01, 2017. doi:10.1001/jamaoncol.2017.0982

Individualized SBRT for hepatocellular cancers