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Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma: An Expert Consensus

 Ted K Yanagihara  ;  Joel E Tepper  ;  Andrew M Moon  ;  Aisling Barry  ;  Meritxell Molla  ;  Jinsil Seong  ;  Ferran Torres  ;  Smith Apisarnthanarax  ;  Michael Buckstein  ;  Higinia Cardenes  ;  Daniel T Chang  ;  Mary Feng  ;  Chandan Guha  ;  Christopher L Hallemeier  ;  Maria A Hawkins  ;  Morten Hoyer  ;  Hiromitsu Iwata  ;  Salma K Jabbour  ;  Lisa Kachnic  ;  Jordan Kharofa  ;  Tae Hyun Kim  ;  Alexander Kirichenko  ;  Eugene J Koay  ;  Hirokazu Makishima  ;  Joel Mases  ;  Jeffrey J Meyer  ;  Pablo Munoz-Schuffenegger  ;  Dawn Owen  ;  Hee Chul Park  ;  Jordi Saez  ;  Nina N Sanford  ;  Marta Scorsetti  ;  Grace L Smith  ;  Jennifer Y Wo  ;  Sang Min Yoon  ;  Theodore S Lawrence  ;  Maria Reig  ;  Laura A Dawson 
 PRACTICAL RADIATION ONCOLOGY, Vol.14(2) : 134-145, 2024-03 
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Ambulatory Care Facilities ; Carbon ; Carcinoma, Hepatocellular* / radiotherapy ; Consensus ; Humans ; Liver Neoplasms* / radiotherapy
Purpose: External beam radiation therapy (EBRT) is a highly effective treatment in select patients with hepatocellular carcinoma (HCC). However, the Barcelona Clinic Liver Cancer system does not recommend the use of EBRT in HCC due to a lack of sufficient evidence and intends to perform an individual patient level meta-analysis of ablative EBRT in this population. However, there are many types of EBRT described in the literature with no formal definition of what constitutes “ablative.” Thus, we convened a group of international experts to provide consensus on the parameters that define ablative EBRT in HCC. Methods and Materials: Fundamental parameters related to dose, fractionation, radiobiology, target identification, and delivery technique were identified by a steering committee to generate 7 Key Criteria (KC) that would define ablative EBRT for HCC. Using a modified Delphi (mDelphi) method, experts in the use of EBRT in the treatment of HCC were surveyed. Respondents were given 30 days to respond in round 1 of the mDelphi and 14 days to respond in round 2. A threshold of ≥70% was used to define consensus for answers to each KC. Results: Of 40 invitations extended, 35 (88%) returned responses. In the first round, 3 of 7 KC reached consensus. In the second round, 100% returned responses and consensus was reached in 3 of the remaining 4 KC. The distribution of answers for one KC, which queried the a/b ratio of HCC, was such that consensus was not achieved. Based on this analysis, ablative EBRT for HCC was defined as a BED10 ≥80 Gy with daily imaging and multiphasic contrast used for target delineation. Treatment breaks (eg, for adaptive EBRT) are allowed, but the total treatment time should be ≤6 weeks. Equivalent dose when treating with protons should use a conversion factor of 1.1, but there is no single conversion factor for carbon ions. Conclusions: Using a mDelphi method assessing expert opinion, we provide the first consensus definition of ablative EBRT for HCC. Empirical data are required to define the a/b of HCC. © 2023
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
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