Stereotactic body radiotherapy in the management of hepatocellular carcinoma: An Australian multi‐institutional patterns of practice review

Abstract

IntroductionStereotactic body radiotherapy (SBRT) is an emerging, therapeutic option in the management of hepatocellular carcinoma (HCC). A multicentre Liver Ablative Stereotactic Radiation (LASR) database was established to provide a collaborative platform for Australian institutions to define the practice of liver SBRT for HCC. This study explores the patterns of SBRT practice amongst Australian institutions.MethodsThis was a multi‐institutional retrospective study of patients treated with SBRT for HCC at 10 institutions between January 2013 and December 2019. Patients' demographics, disease characteristics and SBRT details were evaluated.ResultsThree hundred and seventeen patients were evaluated with a median age of 67 years (range, 32–90). Liver cirrhosis was present in 88.6%, baseline Child‐Pugh score was A5/6 in 85.1% and B7/8 in 13.2%. Median size of HCC treated was 30 mm (range, 10–280). 63.1% had early‐stage disease (Barcelona clinic liver cancer (BCLC) stage 0/A) and 36% had intermediate/advanced‐stage disease (BCLC B/C). In 2013/2014, six courses of SBRT were delivered, increasing to 108 in 2019. SBRT was prescribed in five fractions for 71.3% of the cohort. The most common dose fractionation schedule was 40 Gy in five fractions (24.3%). Median biologically effective dose (BED10) delivered was 85.5 Gy for early‐stage and 60 Gy for intermediate/advanced disease, respectively. The most common prescription range was 100–120 Gy BED10 (32.8%).ConclusionSBRT utilisation for HCC is increasing in Australia. There was wide variation in size of tumours and disease stages treated, and prescription patterns. Uniform reporting of clinical and dosimetric details are important in refining the role of liver SBRT.

Comparison of outcomes following surgical resection, percutaneous ablation or stereotactic body radiation therapy in early‐stage, solitary and small (≤3 cm) treatment‐naïve hepatocellular carcinoma

“…In Australia, we have observed an increased utilisation of SBRT in the management of HCC including as a first‐line, curative intent treatment. 9 An Australia multi‐centre retrospective review reported outcomes following curative intent SBRT in 68 patients with treatment naïve BCLC early‐stage, solitary HCC up to 5 cm with compensated CP A cirrhosis. 18 The two‐year freedom from local progression was 94%, PFS was 60% and OS was 88%.…”

“…Recent systematic reviews of SBRT in early‐stage HCC have demonstrated 3‐year local control rates of 93% 8 . Utilisation of SBRT in HCC has also increased worldwide, with application in a range of disease stages 9 . However, there is limited data on survival outcomes following SBRT in the management of treatment naïve, early‐stage and solitary HCCs.…”

Role of Functional MRI in Liver SBRT: Current Use and Future Directions

“…Liver function is currently assessed via scoring systems such as the Child-Pugh (CP), Albumin-Bilirubin (ALBI) and Model for End-stage Liver Disease (MELD) scores, all of which are based on biochemical markers indirectly linked to liver function [ 8 , 9 ]. Liver SBRT dose prescriptions for HCC are commonly based on the CP scoring system [ 10 ]. CP scores can range from 5 to 15 and are classified as CP-A (5–6 points, well-compensated cirrhosis), CP-B (7–9 points, cirrhosis with significant liver function compromise) and CP-C (10–15 points, decompensated cirrhosis).…”

Guidelines for safe practice of stereotactic body (ablative) radiation therapy: RANZCR 2023 update

“…The uptake of this treatment technique worldwide has been rapid, 2 particularly for lung, 3 spine 4 and liver treatments 5 . In Australia and New Zealand, SABR is available in all states, major cities and some rural centres.…”