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Preface
The concept of "oligometastasis" began in 1995 and represents a critical stage between localized disease and widespread metastasis. Evidence suggests that local treatments, including radiotherapy, surgery, or thermal ablation, prolong the survival of metastases and may provide a potential cure in some cases. However, there is limited evidence for the use of stereotactic ablative radiotherapy (SABR) in oligometastatic hepatocellular carcinoma (HCC). Recently, a prospective study published in the Journal of Hepatology looked at the efficacy and safety of SABR in patients with oligometastatic HCC.
Research Methods:
Studies included primary HCC control and 1 to 5 patients with metastases eligible for SABR. The primary endpoint is treatment efficacy, defined as overall survival (OS) and progression-free survival (PFS). Secondary endpoints included time to local progression, objective response rate, disease control rate, toxicity, and quality of life (QOL), assessed using the EORTC QLQ-C30 before, 0, 1, and 3 months of SABR.
Findings:
Overall, between 2021 and 2022, 40 patients received SABR on 62 lesions. The most common sites of oligometastatic disease (OMD) were the lungs (48.4%), lymph nodes (22.6%), and bones (17.7%).
After a median follow-up of 15.5 months, the 2-year OS was 80%. Median PFS was 5.3 months, with 1-year and 2-year PFS of 21.2% and 0%, respectively.
The time from controlled primary to OMD was shorter (p=0.039, hazard ratio 2.127), and age, Child-Pugh grade, and AFP (p=0.002, 0.004, 0.019) were independently associated with PFS.
The two-year time to local progression, objective response rate, and disease control rate were 91.1%, 75.8%, and 98.4%, respectively.
In terms of safety, acute toxicity occurred in 10% of patients, late toxicity occurred in 7.5% of patients, and there were no grade 3+ toxicities.
All quality of life scores remained stable, while patients without systemic treatment experienced improvements in insomnia and social functioning.
Conclusions of the study
SABR is an effective and feasible method for the treatment of oligometastatic HCC, which can well control local tumors and improve survival without affecting quality of life.
thought
SABR is a non-invasive treatment that is effective in ablating the target lesion. However, in HCC, the concept of OMD or the benefits of SABR are not well understood. According to this study, SABR is an effective and safe treatment option, and for oligometastatic HCC, SABR can achieve good local tumor control and survival improvement regardless of tumor site without worsening the patient's quality of life.
The 1-year PFS was 21.2% and the disease progression rate was 83.5%. Moreover, a range of salvage therapies proved to be effective, with only 3 patients dying from HCC. Twenty-three patients underwent multiple SABR treatments at the site of new metastases at the time of disease progression. This confirms that patients will benefit from early and aggressive systemic therapy or salvage SABR.
The study found that patients with a longer time from primary to OMD showed a better prognosis. PD after SABR can be regarded as early OMD manifestations with a time interval of 4.3 months. Patients with early manifestations of OMD may benefit from early initiation of SABR therapy due to their higher risk of systemic progression.
In addition, the study also identified baseline alpha-fetoprotein (AFP) levels and Child-Pugh grade as important factors influencing PFS. However, for OS, prognostic factors, including time interval, were not statistically significant. These results can be explained by the relatively short follow-up period, with only 6 patients dying, while a large number of patients are still being followed, and long-term follow-up data are important for determining prognostic factors for OS. However, although there is no effect on OS, the time to metastasis and the above factors can still be used as reference indicators and help patients choose SABR.
In conclusion, this is the first prospective study of SABR in oligometastatic HCC, providing insights for the development of new strategies to improve tumor prognosis.
Highlight the point
· SABR is a safe and effective treatment option for oligometastatic HCC.
· AFP level, Child-Pugh grade, and time to OMD performance affect the prognosis of SABR.
· Patients with controlled advanced OMD may benefit from SABR.
文献索引：Choi S H, min Lee B, Kim J, et al. Efficacy of Stereotactic Ablative Radiotherapy in Patients with Oligometastatic Hepatocellular Carcinoma: A Phase II Study[J]. Journal of Hepatology, 2024.
Source: Liver Cancer Online