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defined as lack of failure within the 50% isodose line (ISL). Liver control is defined as lack of recurrence elsewhere within the liver, outside the 50% ISL. Results: Twenty-two patients with HCC were identified, and one patient was excluded due to not being treated with DTT-SBRT. Thus, 21 patients were analyzed. Median age at treatment was 74 (range 36 e 86). Median tumor size was 3.5 cm (range 1.3 e 6.5 cm), and median PTV volume was 119.4 cm 3. Baseline Child-Pugh Score (CPS) was A5/6 in 20 patients (95%), and B8 in 1 patient (5%). Median follow-up was 13.3 months (range 8.2 e 23.6). Actuarial local control was 100% at 1 year and at 2 years. Median time to failure elsewhere in the liver was 18.3 months. Liver control was 75% at 1 year, and 37% at 2 years. Overall survival was 91% at 2 years. In terms of acute toxicities within 3 months of DTT-SBRT, 18 patients (85.7%) did not have any changes in bilirubin or albumin. Grade 3 platelet toxicities occurred in 3/21 patients (14.3%). Three of 21 patients (14.3%) had an increase in CPS by 1 point from A5 to A6. One patient (4.8%) was treated as a bridge to transplant, and this individual had an increase in CPS by 2 points from B8 to B10. There were no grade 4 or 5 toxicities. Conclusion: DTT-SBRT using the VERO system resulted in PTV reduction and minimal acute toxicity, while achieving excellent local control. Most individuals failed elsewhere in the liver, emphasizing the need to spare as much normal liver as possible to allow further locoregional treatment options.

ALBI grades better stratified OS than CP category (Table 1) as CP B7 patients had worse 1-yr OS than CP B8-9, while increasing ALBI grade clearly correlated with decreasing OS (log-rank p<.0001). AUC estimates for ALBI and CP were 74.2% and 65.6%, respectively (p Z .34). Within the subgroup of patients with CP B or C liver disease, ALBI 2 and 3 effectively stratified 1-year OS (62% and 17%, log-rank p Z .004). As seen in Table, ALBI stratified 1-yr risk of liver function decline, with ALBI 1 and 2 grades showing similar rates of decompensation but ALBI 3 with clearly higher rates. Within the CP B or C subgroup, ALBI 2 and 3 effectively stratified risk of 4-month liver function decline (12% vs. 69%, p Z .002), but lost significance comparing risk of 1-yr liver function decline (53% vs. 77%, p Z .19). Conclusion: In a cohort of HCC patients treated with definitive RT, ALBI grade may identify a subgroup of patients with CP B/C liver disease who are safer radiotherapy candidates.

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