Objective: To assess the long-term effectiveness of palliative stereotactic body radiotherapy (SBRT) in patients with large unresectable Barcelona Clinic Liver Cancer stage C hepatitis B-related hepatocellular carcinomas (HCCs). Methods: Consecutive HCC cases treated with fractionated SBRT between January 2008 and December 2010 were analysed. The long-term survival and response rate were evaluated. Univariate and multivariate analyses were performed to identify the significant predictors of survival. Results: In total, 32 cases were analysed, with median gross tumour volume was 509.5 cm 3 (range, 2.2-3088 cm 3 ). Median treatment prescription was 32 Gy (range, in five to 10 fractions over 1 to 2 weeks. Median followup was 13.4 months; median survival was 13.3 months (95% confidence interval [CI]=11.4-15.2). Stable and partial tumour response rates by RECIST criteria were 69% and 31%, respectively. Alpha-fetoprotein reduction at ≥3 months after radiotherapy (p = 0.018) and gain in body weight after SBRT (p < 0.001) were significantly associated with longer survival after multivariate analysis. Conclusion: SBRT with dose individualisation can be delivered safely to large unresectable tumours in patients withHBV-related HCC. The median survival after SBRT in this study was 13.3 months. Alpha-fetoprotein reduction at ≥3 months and weight gain after radiotherapy were positive prognostic factors for longer survival. More prospective studies are warranted to confirm these results.

Objectives: Large (≥10 cm) hepatocellular carcinomas (HCCs) carry a dismal prognosis and respond poorly to transarterial chemoembolisation (TACE). Combined TACE and hypofractionated image-guided radiotherapy (HIGRT) has emerged as a new treatment strategy. We evaluated its efficacy among these tumours and report the predictors of overall survival (OS). Methods: Data from 55 consecutive cases treated with preplanned combined TACE and HIGRT from 2007 to 2017 were evaluated from a prospectively collected database. Patients with advanced HCCs ≥10 cm, ineligible for curative intervention and with Child-Pugh scores ≤B7, received one dose of preplanned TACE 4 weeks prior to HIGRT. HIGRT doses were individualised according to the dose constraints of uninvolved liver and neighbouring organs at risk. OS was the primary endpoint. Results: In all, 55 patients with median tumour sizes of 15.3 cm were included. Tumour vascular thromboses and extrahepatic diseases were present in 25.5% and 32.7%, respectively. The median total equivalent dose in 2 Gy/fr (EQD 2 , α/β ratio = 10) was 32.7 Gy. The 2-year OS reached 24.9%. Clinical benefit rate was 83.6% with a 1-year local control rate of 57.4%. Multivariate analyses revealed alpha-fetoprotein (AFP) level (hazard ratio = 2.2, p = 0.025) and subsequent local treatment (hazard ratio = 0.2, p = 0.001) to be independent OS predictors. Responders undergoing subsequent curative resection achieved significantly better median OS than those without. Conclusion: Combined TACE and HIGRT achieved favourable survival outcomes among large HCCs. AFP level and subsequent local surgery were independent negative and positive OS predictors, respectively. Future studies are warranted.

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Purpose: To evaluate the ability of Child-Pugh (CP) versus albumin-bilirubin (ALBI) grade to predict overall survival (OS) in patients with hepatocellular carcinoma (HCC) undergoing individualised hypofractionated radiotherapy (IHRT) using stereotactic body radiotherapy (SBRT). Methods: We retrospectively reviewed data on our patients with HCC treated with IHRT using SBRT per our institutional protocol from May 2006 to February 2015. We collected CP and ALBI grades prior to treatment and analysed their prognostic value for OS. Results: A total of 174 consecutive patients were included in this study. Among them, 63% were CP grade A5 and 37% were A6. The median ALBI score was-2.39 (range,-3.61 to-1.41) with 35% grade A1 and 65% grade A2. OS was significantly associated with ALBI grade (p = 0.015), but not with CP grade (p = 0.47). On multivariable regression analysis, the ALBI score, tumour size, number of lesions, total biologically effective dose, presence of portal vein thrombosis, and the presence of metastasis were shown to be independent factors for OS. Conclusion: ALBI grade is a better predictor of survival than the CP grade in patients with HCC receiving IHRT.

Despite advances in surgical, radiation and systemic therapy, the prognosis of pancreatic cancer remains poor. Most patients are not amendable to curative surgical resection at presentation. Chemo-radiotherapy is the standard of care for locally advanced pancreatic cancer, but its local control is poor. Stereotactic body radiotherapy (SBRT) is a viable therapeutic option to maximise local control with a tolerable side-effect profile. It enables precise delivery of high-dose radiation over a short period (typically 1-5 days) and leads to better local control, disease outcome, and symptom palliation. SBRT can also be applied in neoadjuvant, adjuvant, or re-irradiation treatment. We review the technology, clinical application, and future direction of SBRT for treatment of pancreatic cancer.