In Regard to Apisarnthanarax et al

Abstract

Apisarnthanarax et al 1 Apisarnthanarax S Barry A Cao M et al. External beam radiation therapy for primary liver cancers: An ASTRO clinical practice guideline. Pract Radiat Oncol. 2022; 12: 28-51 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar published a recent guideline, “External Beam Radiation Therapy for Primary Liver Cancers: An ASTRO Clinical Practice Guideline.” The task force recommendations are an excellent resource for practical, evidence-based recommendations for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC). However, in developing these guidelines, the authors excluded studies in which external beam radiation therapy was not part of the therapeutic approach. Doing this, unfortunately, results in the omission of percutaneous interstitial high-dose-rate (HDR) brachyablation, which is a guideline-endorsed treatment for HCC from the most recent European Society for Medical Oncology Clinical Practice Guidelines. 2 Vogel A Martinelli E ESMO Guidelines CommitteeUpdated treatment recommendations for hepatocellular carcinoma (HCC) from the ESMO Clinical Practice Guidelines. Ann Oncol. 2021; 32: 801-805 Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar High-dose-rate brachyablation is supported by data from phase 1-2 trials. 3 Mohnike K Wieners G Schwartz F et al. Computed tomography-guided high-dose-rate brachytherapy in hepatocellular carcinoma: Safety, efficacy, and effect on survival. Int J Radiat Oncol Biol Phys. 2010; 78: 172-179 Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar ,4 Ricke J Wust P Stohlmann A et al. CT-guided interstitial brachytherapy of liver malignancies alone or in combination with thermal ablation: Phase I-II results of a novel technique. Int J Radiat Oncol Biol Phys. 2004; 58: 1496-1505 Abstract Full Text Full Text PDF PubMed Scopus (122) Google Scholar A recent randomized phase 2 trial also demonstrated superior oncologic outcomes with HDR brachyablation, prescribed to a minimum target dose of 15 Gy in 1 fraction, versus transarterial embolization in unresectable HCC. 5 Mohnike K Steffen IG Seidensticker M et al. Radioablation by image-guided (HDR) brachytherapy and transarterial chemoembolization in hepatocellular carcinoma: A randomized phase II trial. Cardiovasc Intervent Radiol. 2019; 42: 239-249 Crossref PubMed Scopus (14) Google Scholar In Reply to Nguyen et alPractical Radiation OncologyVol. 12Issue 3PreviewWe thank Nguyen et al1 for their comments regarding high-dose rate (HDR) brachytherapy in “External Beam Radiation Therapy for Primary Liver Cancers: An ASTRO Clinical Practice Guideline.”2 HDR brachytherapy is a treatment modality available in a limited number of specialized experienced treatment centers. HDR brachytherapy is notably absent as a standard treatment option in the National Comprehensive Cancer Network guidelines and the updated Barcelona clinic liver cancer staging system/treatment recommendations. Full-Text PDF