Impact of Fractionated Stereotactic Body Radiotherapy on Liver Function in Patients with Hepatitis B Virus–related Hepatocellular Carcinoma: Clinical and Dosimetric Analysis

• Published in: Hong Kong journal of radiology : HKJR = Xianggang fang she ke yi xue za zhi Vol. 16; no. 2; pp. 94 - 99
• Main Authors: Choi, CKK, Lee, FAS, Lam, TC, Wong, FCS, Wong, VY, Lui, C, Sze, WK, Tung, SY
• Format: Journal Article
• Language: English
• Published: Hong Kong Hong Kong Academy of Medicine 01.06.2013
• Subjects: Hepatitis B; Interferon; Liver cancer; Liver diseases; Radiation therapy
• ISSN: 2223-6619; 2307-4620
• DOI: 10.12809/hkjr1312147

Objective: To investigate the impact of fractionated stereotactic body radiotherapy (SBRT) on liver function and identify any dosimetric parameters that may predict deterioration of liver function in patients with hepatitis B (HBV)–related hepatocellular carcinoma (HCC). Methods:Thirty-six eligible patients with HBV-related HCC who were treated with fractionated SBRT between January 2008 and December 2010 were assessed. The treatment prescription ranged from 20 to 40 Gy (median, 32 Gy) in 5 to 10 fractions over 1 to 2 weeks. All the patients received pre-emptive antiviral therapy. The median gross tumour volume was 509 cm3 (range, 2-3088 cm3). Four liver toxicity endpoints were assessed: (1) rate of HBV reactivation; (2) rate of chronic hepatitis B exacerbation; (3) rate of radiotherapy-induced liver disease; and (4) rate of deterioration in Child-Pugh class. Clinical and dosimetric parameters were evaluated to identify the significant predictors of liver toxicity. Results:No patient developed HBV reactivation, chronic hepatitis B exacerbation, or radiotherapy-induced liver disease within 3 months after SBRT. Four (11%) experienced Child-Pugh class deterioration. On univariate analysis, no clinical and dosimetric parameters were identified as predictors of Child-Pugh class deterioration. Conclusion:SBRT with individualised dosing of up to 40 Gy in 10 fractions can be delivered safely to patients with large unresectable HBV-related HCC in palliative setting. Pre-emptive antiviral therapy is probably mandatory to prevent HBV-related complications in this setting.