Evaluation of Hepatic Toxicity after Repeated Stereotactic Body Radiation Therapy for Recurrent Hepatocellular Carcinoma using Deformable Image Registration

Abstract

This study aimed to evaluate hepatic toxicity after repeated stereotactic body radiation therapy (SBRT) for recurrent hepatocellular carcinoma (HCC) using deformable image registration (DIR). Between January 2007 and December 2015, 85 patients who underwent two sessions of SBRT for HCC treatment were retrospectively analyzed. A DIR technique was used to calculate the cumulative dose of the first and second SBRT to the normal liver by matching two computed tomography simulation images. The Dice similarity coefficient (DSC) index was calculated to evaluate DIR accuracy. Before the first and second SBRT, 6 (7.1%) and 12 (14.1%) patients were Child-Pugh class B, respectively. Median tumor size was 1.7 cm before both SBRT treatments. Mean DSC index value was 0.93, being >0.9 in 79 (92.9%) registrations. Median cumulative mean liver dose (MLD) was 9.3 Gy (interquartile range, 7.6–11.7). Radiation-induced liver disease developed in three patients, and two of them, with Child-Pugh class B, experienced irreversible liver function deterioration following the second SBRT. The DIR method provided reliable information regarding cumulative doses to the liver. In patients with Child-Pugh class A liver function, repeated SBRT for small recurrent HCC could be safely performed with acceptable hepatic toxicity.

Stereotactic Body Radiotherapy as a Salvage Therapy after Incomplete Radiofrequency Ablation for Hepatocellular Carcinoma: A Retrospective Propensity Score Matching Study

“…Their obtained probability distributions of the expected OS were nearly identical with 6.452 and 6.371 years in the RFA and SBRT groups, respectively. Recently, Lee et al reported that repeated SBRT for recurrent HCC could be safely performed with acceptable hepatic toxicity [24]. These results encouraged the use of SBRT as a comparable treatment to RFA for RHCC after RFA.…”

Comparison of stereotactic body radiotherapy and radiofrequency ablation for hepatocellular carcinoma: Systematic review and meta‐analysis of propensity score studies

“…In regards to this issue, some retrospective studies published in recent years have reported that repeated SBRT for recurrent HCC was safely performed with acceptable hepatic toxicity. [41][42][43] In order to clarify long-term liver toxicities of both treatments, prospective studies in larger numbers of patients are necessary.…”

Current status of stereotactic body radiotherapy for the treatment of hepatocellular carcinoma

“…Considering that frequent intrahepatic recurrences of HCC require repeated treatments, SBRT might be spared for lesions unsuitable for other liver-directed treatments. In contrast, Lee et al [32] reported the treatment outcomes after a repeated SBRT for recurrent HCCs with a median tumor size of 1.7 cm (interquartile range, 1.4–2.2 cm) in 85 patients. The 3-year local control rates were not different between the first and second SBRT (94.9% vs. 90.4%, p =0.667).…”

“…Biliary stricture has been occasionally reported at the rate of 0–3% [12,28,32,46-48]. Eriguchi et al [49] found biliary stenosis in 2 out of 50 patients irradiated with over 20 Gy to the central biliary system; 1 patient experienced biliary stricture at the area irradiated with >80 Gy after the second SBRT and the stenotic site of the other patient was outside the area irradiated with >20 Gy.…”