Stereotactic body radiotherapy delivered with IMRT for oligometastatic regional lymph node metastases in hepatocellular carcinoma: a single-institutional study.

The optimal treatment to lymph node metastases in hepatocellular carcinoma (HCC) has not been established, yet. Our aim was to evaluate the local control, the survival benefit and the toxicity of stereotactic body radiotherapy (SBRT) delivered with intensity-modulated radiotherapy (IMRT) to oligometastatic regional lymph node in HCC patients. We retrospectively analyzed 15 patients with HCC treated with SBRT delivered using IMRT to 24 regional lymph node metastases. Dose prescriptions were set to 45 Gy in 6 fractions of 7.5 Gy for solitary lesions and 49.5 Gy in 9 fractions of 5.5 Gy for multiple lesions. For the planning target volume, the plan was optimized aiming for a V95% > 90%. The study endpoints were freedom from local progression (FFLP), progression-free survival (PFS), overall survival (OS) and toxicity. The median follow-up was 18.1 months. The 1-year and 2-year FFLP rates were 100 and 90 ± 9.5%, respectively. The 1-year PFS rate was 46.7 ± 12.9%, and the 1-year and 2-year OS rates were 73.3 ± 11.4 and 28.6 ± 12.7%, respectively. Only one patient had a duodenal ulcer and three patients had liver enzyme elevation in sub-acute toxicity, however there was no grade ≥ 3 toxicity. In conclusion, SBRT delivered with IMRT to lymph node metastases can offer excellent local control with minimal toxicity, and SBRT may improve HCC patients' survival more than conventional radiotherapy.

The role of changes in maximum standardized uptake value of FDG PET-CT for post-treatment surveillance in patients with head and neck squamous cell carcinoma treated with chemoradiotherapy: preliminary findings.

OBJECTIVE: No clear consensus exists regarding the optimal interval and frequency of follow-up positron emission tomography (PET)-CT in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemoradiotherapy (CRT). Here, we sought to clarify whether the changes in the maximum standardized uptake value (ΔSUVmax) may be a valid parameter to help decision-making for surveillance management after CRT. METHODS: 40 patients underwent PET-CT at pre-treatment and 3 months after CRT. Patients were followed by sequential PET-CT for 2 years after CRT. The ΔSUVmax of the primary tumour and the metastatic nodes were calculated between pre-treatment and 3 months after the CRT, and we evaluated the associations between ΔSUVmax and the manifestation of recurrence, time to recurrence and the patient survival. RESULTS: The ΔSUVmax of the primary tumour was significantly lower for the lesions with recurrence than that for those with non-recurrence for both the primary site and the nodal site (p = 0.007, 0.02). A significant correlation was found between the time to recurrence and the ΔSUVmax of the primary tumour (r = 0.63, p < 0.05). The threshold ΔSUVmax of the primary tumour of 1.04 revealed 76.9% sensitivity and 86.4% specificity for distinguishing recurrence from non-recurrence. The progression-free survival and overall survival of the two patient groups divided by the ΔSUVmax of the primary tumour at 1.04 showed a significant difference (p = 0.003, 0.02). The ΔSUVmax of the metastatic nodes did not show a significant association with recurrence or patient survival. CONCLUSION: The ΔSUVmax of the primary tumour showed a significant association with recurrence and patient survival. Advances in knowledge: The ΔSUVmax of the primary tumour may be a valid clinical parameter to help decision-making for the surveillance management of patients with HNSCC after CRT.

Lesion regression rate based on RECIST: prediction of treatment outcome in patients with head and neck cancer treated with chemoradiotherapy compared with FDG PET-CT.

The aim of this study was to evaluate whether the lesion regression rate (ΔLR) based on the Response Evaluation Criteria in Solid Tumors (RECIST) criteria could be used for the prediction of treatment outcome in head and neck squamous cell carcinoma (HNSCC) patients treated with chemoradiotherapy (CRT) compared with FDG PET-CT. A total of 33 patients underwent MRI and PET-CT at pretreatment and at 8 weeks after CRT. We assessed the treatment outcome by analyzing the following parameters: the RECIST criteria, ΔLR, the European Organization for Research and Treatment of Cancer (EORTC) criteria, and pretreatment SUVmax of the primary tumor and node. The correlation between the analysis of the parameters and the results of the long-term follow-up of the patients was determined. The RECIST did not significantly correlate with locoregional control (LRC) or survival. The ΔLR was significantly lower for the lesions with locoregional failure (LRF) than for those with LRC. A threshold ΔLR of 48% revealed a sensitivity of 72.7% and specificity of 77.3% for the prediction of LRF. Progression-free survival (PFS) of patients with ΔLR ≥ 48% was significantly better than that of patients with ΔLR < 48% (P = 0.001), but not overall survival. There was a significant correlation between LRC and the EORTC (P = 0.02). The patients who achieved a complete response by the EORTC criteria showed significantly better PFS and overall survival (P = 0.01 and 0.04, respectively). The ΔLR was inferior to FDG PET-CT with respect to the prediction of patient survival; however, it may be useful for selecting patients in need of more aggressive monitoring after CRT.