Does Vascular Collapse Occur After Treatment of Hepatocellular Cancer With Stereotactic Body Radiation Therapy?

There is debate about why stereotactic body radiation therapy (SBRT) produces superior control of hepatocellular cancer (HCC) compared to fractionated treatment. Both preclinical and clinical evidence has been presented to support a classic biological explanation: the greater BED of SBRT produces more DNA damage and tumor cell kill. More recently, preclinical evidence has supported the concept of a new biology, particularly radiation-induced vascular collapse, which increases hypoxia and free radical activation. This is hypothesized to cause much greater tumor cell death than was produced by the initial radiation-induced DNA damage to the tumor. We decided to investigate if vascular collapse occurs after standard SBRT for patients with HCC. Eight patients with 10 lesions underwent dynamic contrast enhanced MRI at the time of simulation and either 48 or 96 hours after the first fraction. Only three of 10 tumors showed a decrease in blood flow. These findings suggest that vascular collapse does not typically occur after SBRT for HCC. (c) 2023 Elsevier Inc. All rights reserved.

Automated summary

There is debate about why SBRT is more effective in controlling HCC compared to fractionated treatment. Classic biological explanation suggests that the higher BED of SBRT causes more DNA damage and tumor cell kill. However, recent preclinical evidence supports a new biology involving radiation-induced vascular collapse, which leads to increased tumor cell death. This study found that vascular collapse does not typically occur after standard SBRT for HCC.