Long‐term outcome of stereotactic body radiotherapy for patients with small hepatocellular carcinoma

Abstract

Aim:To evaluate the long-term outcome of stereotactic body radiotherapy in patients with small hepatocellular carcinoma who were ineligible for resection or ablation therapies.Methods: A total of 65 patients with 74 hepatocellular carcinomas (median tumor size 16 mm) were enrolled in the present study. They were treated with the prescribed dose of 48 Gy in four fractions at the isocenter. We extended the observation period and analyzed long-term outcomes, including overall survival, progression-free survival, local control, and various prognostic factors, in these patients. Results:The median follow-up period was 41 months for all patients and 62 months for surviving patients. The 3-and 5-year overall survival rates were 56.3% (95% confidence interval, 44.1-68.5%) and 41.4% (95% confidence interval, 28.7-54.1%), respectively. The 3-and 5-year progression-free survival rates were 25.4% (95% confidence interval, 14.0-36.8%) and 10.6% (95% confidence interval, 1.5-19.8%), respectively. The 3-and 5-year local control rates were both 100% (95% confidence interval 100%). Liver toxicities exceeding grade 3 were observed in 15 patients (23.1%). The proportion of patients who had grade ≥3 toxicities did not increase. Adverse effects (grade ≤2) presented as significant prognostic factors of overall survival, while TNM stage (T1N0M0) was a significant prognostic factor of progression-free survival after multivariate analysis.Conclusions: Stereotactic body radiotherapy was effective for patients with small hepatocellular carcinomas who were ineligible for resection or ablation therapies. The incidence of grade ≥3 adverse effects did not increase, even after longer follow-up times.

Current Status Regarding Tumour Progression, Surveillance, Diagnosis, Staging, and Treatment Of HCC: A Literature Review

“…SBRT is applied in patients with lesions which is located near to the central portal area and close to hepatic vessels and near to the biliary system. SBRT is primarily used in the patients with small HCC who cannot undergo to surgery, RFA, or transplantation [52] .…”

Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

“…Prospective and retrospective studies of SBRT in patients with BCLC Stage A HCC demonstrate excellent local control rates (►Table 1). 45,[48][49][50][51][52][53] In this population, SBRT is commonly performed as salvage treatment after RFA failure or for tumors ineligible for ablation due to size, location, or ultrasound visibility. An early prospective trial from the Netherlands treated eight HCC patients with single lesions up to 7 cm with CP Class A or no cirrhosis and found 1-year local control rates of 80%.…”

“…50 In contrast, grade 3 or higher toxicities were reported as 11% in the Indiana University CP Class A patients, 16% in the Netherlands study, 23.1% in the Hiroshima University study, and 38% in the Indiana University CP Class B patients. 48,49,51,52 There are likely institutionspecific differences in balancing the trade-offs between patient selection, tumor dose escalation, and conservative dosing of the unaffected bowel and liver, as well as potential biological differences in liver sensitivity to RT between regions due to the endemic hepatitis B in Asia. More information is required to elucidate the differences.…”

Utility of radiomics for predicting patient survival in hepatocellular carcinoma with portal vein tumor thrombosis treated with stereotactic body radiotherapy

“…Previous studies have reported that the natural median survival time of patients with HCC and PVTT is 2-4 months [8,9]. Several clinical studies have con rmed that radiotherapy is effective for treating HCC with PVTT [10][11][12].…”

“…Stereotactic body radiotherapy (SBRT) has emerged as a new radiotherapy technology that can deliver high doses of radiation to the target area in fewer fractions [13][14][15]. SBRT can accurately transfer a large dose of multiple beams to the target tumor within 1 to 5 fractions, owing to technical progress in accurate dose transfer, respiratory movement management, and daily image guidance.…”