Long-term effect of stereotactic body radiation therapy for primary hepatocellular carcinoma ineligible for local ablation therapy or surgical resection. Stereotactic radiotherapy for liver cancer

Abstract

BackgroundWe evaluated the long-term effect of stereotactic body radiation therapy (SBRT) for primary small hepatocellular carcinoma (HCC) ineligible for local therapy or surgery.MethodsForty-two HCC patients with tumors ≤ 100 cc and ineligible for local ablation therapy or surgical resection were treated with SBRT: 30-39 Gy with a prescription isodose range of 70-85% (median 80%) was delivered daily in three fractions. Median tumor volume was 15.4 cc (3.0-81.8) and median follow-up duration 28.7 months (8.4-49.1).ResultsComplete response (CR) for the in-field lesion was initially achieved in 59.6% and partial response (PR) in 26.2% of patients. Hepatic out-of-field progression occurred in 18 patients (42.9%) and distant metastasis developed in 12 (28.6%) patients. Overall in-field CR and overall CR were achieved in 59.6% and 33.3%, respectively. Overall 1-year and 3-year survival rates were 92.9% and 58.6%, respectively. In-field progression-free survival at 1 and 3 years was 72.0% and 67.5%, respectively. Patients with smaller tumor had better in-field progression-free survival and overall survival rates (<32 cc vs. ≥32 cc, P < 0.05). No major toxicity was encountered but one patient died with extrahepatic metastasis and radiation-induced hepatic failure.ConclusionsSBRT is a promising noninvasive-treatment for small HCC that is ineligible for local treatment or surgical resection.

Current management of hepatocellular carcinoma: An Eastern perspective

“…Radiation therapy has currently been adopted as a definitive therapy with curative intent if the tumor is at an early stage. Particularly, stereotactic body radiation therapy can achieve high rates of locoregional tumor control as it can deliver high doses of radiation in a single treatment session or in a small number of fractions [97,98] . In locally advanced HCCs, radiation therapy can be used to relieve obstruction and improve portal blood flow if the tumor invades the biliary tree or portal vein [99,100] .…”

Evaluation of response after SBRT for liver tumors

“…[18][19][20][21][22] Other publications apply recommended EASL or mRECIST criteria. [23][24][25][26][27] A single article compared the RECIST and EASL criteria in this indication. Price et al reported in 2012 on a series of 26 patients treated for 29 CHC by SBRT by comparing the morphological evolution according to the RECIST and EASL criteria 16 ( Table 1).…”

Stereotactic body radiation therapy in hepatocellular carcinoma: Optimal treatment strategies based on liver segmentation and functional hepatic reserve

“…Andolino et al 13 reported that when approximately 40% of patients had a CP-B score, 37% of patients experienced >grade 3 toxicity. In Korea, Kwon et al 27 reported a 1-year OS of 93% and RILD in 2% of patients treated with either 3 × 13 Gy for tumor volumes <30 cm 3 or 3 × 10-12 Gy for tumor volumes >30 cm 3 . For larger tumors, Kang et al 16 treated 47 patients with tumors which ranged in size from 1.3 to 7.8 cm using a regimen of 3 × 14-20 Gy, with a resulting 2-year OS of 69% and grade 3 RILD of 13%.…”