Research Discussion

930 views

Published on

Moderated by : Professor Jinsil Seong

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
930
On SlideShare
0
From Embeds
0
Number of Embeds
584
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Research Discussion

  1. 1. 1 Research Discussion Moderated by : Professor Jinsil Seong
  2. 2. 22 What has been published?
  3. 3. 3 CyberKnife for Liver Cancer Inoperable primary hepatocellular carcinoma Combined with transarterial chemoembolization (TACE)1 As sole treatment when other local therapies not indicated2 For recurrences3 Cholangiocarcinoma in combination with chemotherapy4 As a bridge to transplant7 Liver metastases From various primary tumors5 In patients treated multiple times6 #XXXXXXX — Company Confidential 1Choi et al. BMC Cancer 2008;8:351. 2Louis et al. Technol Cancer Res Treat 2010;9:479-487. 3Huang et al. International journal of radiation oncology, biology, physics 2012;84:355-361. 4Park et al. Gut Liver 2010;4:103-105. 5Ambrosino et al. Anticancer Res 2009;29:3381-3384. 6Lanciano et al. Front Oncol 2012;2:23. 7O’Connor et al. Liver Transplant, 2012 Aug;18(8):949-54.
  4. 4. 4 CyberKnife for Liver Cancer  Korea institute of Radiological and Medical Science SBRT for inoperable HCC as a salvage after incomplete TACE  Retrospective  2008-2011, 50 patients (C-P A/B, tumor <10cm, 1-5 TACE before RT)  Median prescribed dose: 57 Gy in 3 fractions (range, 42-60 Gy)  Response rate at 6 mo: 76.6% (CR in 38.3%, PR in 38.3%)  2 Y LC: 94.6%, 2 Y OS: 68.7% Korea Kang et al. Cancer. 2012;118:5424-31. Kwon et al. BMC Cancer. 2010 Sep 3;10:475  The Catholic Univ. of Korea Long term effect of SBRT for HCC ineligible for local treatment  Retrospective  2004-2007, 42 patients (C-P A/B, tumor <100 cc, without PVTT)  Median prescribed dose: 33 Gy in 3 fractions (range, 30-39 Gy)  In-field response rate at 1 mo: 85.8% (CR in 59.6%, PR in 26.2%)  1Y OS: 92.9%, 3Y OS: 58.6%
  5. 5. 5 CyberKnife for Liver Cancer  National Defense Medical Center SBRT for inoperable recurrent HCC  Retrospective  2008-2009, 36 patients (recurrent tumor after curative treatment)  Median prescribed dose: 37 Gy in 4-5 fractions (range, 25-48 Gy)  Response rate: 58.6% (CR in 22%, PR in 36.6%)  2Y OS: 64%  Matched-pair analysis with 138 patients given other or no treatment - 2Y OS: 72.6% in SBRT group, 42.1% in control group (p=0.013)  National Defense Medical Center SBRT or 3DRT for PVTT in HCC patients  Prospective  2002-2004, 43 patients (22 in SBRT group, 21 in 3DRT group)  Median prescribed dose- SBRT: 45 Gy in 15 fractions/ 3DRT: 45 Gy in 25 fractions  Response rate: 79% (CR in 7%, PR in 71%)  1Y OS: 100% in CR, 56% in PR Taiwan Huang et al. IJROBP 2012 Oct 1;84(2):355-61 Lin CS et al. JJCO 2006 Apr;36(4):212-7
  6. 6. 6 CyberKnife for Liver Cancer  Tianjin Cancer Hospital Radiosurgery for primary HCC  Retrospective  2006-2008, 17 patients (stage I-III, 12 patients received local treatment)  Median prescribed dose: 45 Gy in 3-8 fractions (range, 39-52 Gy)  Response rate: 100% China Liu et al. Zhonghua Zhong Liu Za Zhi. 2010 Mar;32(3):229-33.
  7. 7. 7 CyberKnife for Liver Cancer  University Hospital Domaine Universitaire Sart Tilman, Belgium SBRT for inoperable HCC  Retrospective  25 patients (CP-A/B, single tumor)  Median prescribed dose: 45 Gy in 3 fractions  2Y local control: 95%  1Y OS: 79%, 2Y OS: 52%  Baylor Univ. Medical center Dallas, USA Long-Term Outcomes of SBRT in HCC as a Bridge to Transplantation  Retrospective  2005-2010, 10 patients  Median prescribed dose: 51 Gy in 3 fractions (range, 33-54 Gy)  CR in 27%, 5Y OS & DFS: 100% Europe / US Louis et al. TCRT.Volume 9, Number 5, October 2010 Oconnor et al. Liver Transl 2012 Aug;18:949-954
  8. 8. 8 CyberKnife for Liver Cancer  Indiana Univ. School of Medicine, USA Phase I feasibility trial of SBRT for HCC  Prospective, Dose escalation  21 patients (CP-A/B, tumor ≤ 6 cm)  Protocol scheme: 36 Gy in 3 fractions > planned escalation until reaching MTD  2Y local control: 100%, 1Y OS: 75%, 2Y OS: 60% Europe / US Price et al. Cancer. 2012 Jun 15;118(12):3191-8 Cardenes et al. Clin Transl Oncol. 2010 Mar;12(3):218-25  Indiana Univ. School of Medicine, USA Radiosurgery for primary HCC  Retrospective  2006-2008, 17 patients (stage I-III, 12 patients received local treatment)  Median prescribed dose: 45 Gy in 3-8 fractions (range, 39-52 Gy)  Response rate: 100%
  9. 9. 9 CyberKnife for Liver Cancer  Centre Oscar Lambret, Lille, France IG-IMRT for unresectable liver metastasis  Retrospective  2007-2009, 42 patients  Median prescribed dose: 40 Gy in 4 fractions/45 Gy in 3 fractions  1Y LC: 90%, 2Y LC: 86%  1Y OS: 94%, 2Y OS: 48% Europe / US Vautraver et al. IJROBP 2011 Nov 1;81:39-47
  10. 10. 10 TomoTherapy for Liver Cancer • Locally advanced • Large lesions • Multiple lesions • Liver metastases #XXXXXXX — Company Confidential
  11. 11. 11 TomoTherapy for Liver Cancer  The Catholic Univ. of Korea Simultaneous multi-target RT for HCC with multiple extrahepatic mets  Retrospective  42 patients (152 intra and extrahepatic metastases)  Median prescribed dose: 33 Gy in 3 fractions (range, 30-39 Gy)  In-field response rate at 1 mo: 85.8% (CR in 59.6%, PR in 26.2%)  1Y OS: 92.9%, 3Y OS: 58.6%  Yonsei Univ. of Korea Optimal RT technique for locally advanced HCC  2006-2007, 12 patients, 60 Gy in 30 fractions  Comparison of plans(3D-CRT, linac-based IMRT and helical tomotherapy)  Lower irradiated liver volume at 40, 50 and 60 Gy  Superior tumor coverage #XXXXXXX — Company Confidential Korea Jang et al. IJROBP 2009 Nov 1;81:39-47 Lee et al. JJCO. 2011 Jul;41(7):882-9
  12. 12. 12 TomoTherapy for Liver Cancer  Shin-Kong Memorial Hospital, National Yang-Ming University Angiogenic blockade and RT in HCC  Retrospective  2007-2008, 23 patients, RT + sunitinib  Median prescribed dose: 52.5 Gy in 15 fractions  Response rate: 74%  1Y OS: 70%  Vrije Univ. Brussel, Belgium Phase II study in the multidisciplinary Tx of oligometastatic CRC  24 patients(≤ 5 metastases, in lung, liver, LN)  Median prescribed dose: 50 Gy in 5 fractions  Response rate in metastatic lesion: 55%  1Y LC: 54%, 1Y PFS: 14%, 1Y OS: 78% #XXXXXXX — Company Confidential Chi et al. IJROBP. 2010 Sep 1;78(1):188-93 Engels B et al. Radiation Oncology. 2012 Mar 16;7:34
  13. 13. 1313 Current Research Interests?
  14. 14. 14 HCC studies and protocols  Korea CK  led by Kim of Korea Cancer Center Hospital, multi-institution studies  Incomplete response after TACE? Sample size?  60Gy in 3?  2-year local control, OS?  Taiwan CK  led by Ren of Tri-Service General Hospital, Taiwan, multi-institution studies  TACE ineffective or unsuitable, sample size 150  Randomized, arm A – SABR and/or Thalidomide/Sorafenib, 4.5-6.5 per faction, 1F per day, 10 fractions, total 45-60Gy; arm B – TACE and/or Thalidomide/Sorafenib or observation  Safety profile, local control and PFS, OS in two years  China CK  led by Song of Tianjin Cancer Hospital, multi-institution studies  Naïve patients, sample size 100  45Gy in 3  OS at 1 and 2-year; local control, PFS and acute and late toxicities  Korea TT  led by Seong of Yonsei University Medical College  9-13Gy x 4f
  15. 15. 1515 Future Research Direction?
  16. 16. 16 Standardizing protocol? Criteria in selecting the patients? Impact of target delineation strategies? Dose and fractionation scheme? The treatment margins for CK or TT? Ways of image guidance and motion management? How can we connect the guidelines to medical associations in different countries? SBRT (CyberKnife) and IG-IMRT (TomoTherapy) #XXXXXXX — Company Confidential
  17. 17. 17 Future Research and Regional Synergy Future research areas/direction? Possible regional collaboration ? #XXXXXXX — Company Confidential

×