SBRT for Hepatocellular Carcinoma: 8-Year Experience from a Regional Transplant Center

• Published in: Journal of gastrointestinal cancer Vol. 49; no. 4; pp. 463 - 469
• Main Authors: Qiu, Haoming, Moravan, Michael J., Milano, Michael T., Usuki, Kenneth Y., Katz, Alan W.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2018
• Subjects: Aged; Cancer Research; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - physiopathology; Carcinoma, Hepatocellular - radiotherapy; Disease-Free Survival; Dose Fractionation, Radiation; Female; Gastroenterology; Humans; Internal Medicine; Liver - pathology; Liver - physiopathology; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - physiopathology; Liver Neoplasms - radiotherapy; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Original Research; Patient Selection; Radiation Injuries - epidemiology; Radiation Injuries - etiology; Radiosurgery - adverse effects; Radiosurgery - methods; Radiotherapy; Retrospective Studies; Survival Rate; Treatment Outcome; Hepatocellular carcinoma; Child-Pugh B and C; SBRT; Non-transplant candidates
• ISSN: 1941-6628; 1941-6636
• DOI: 10.1007/s12029-017-9990-1

Purpose The study aimed to evaluate stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) in patients not eligible for liver transplant (LT). Methods We retrospectively identified transplant-ineligible HCC patients treated with SBRT to the liver between 2004 and 2013. Our primary endpoint was overall survival (OS). We also report treatment toxicities using CTCAE 3.0, radiographic response, and patterns of failure. Results We identified 93 patients with median age at SBRT of 65.8 years. Forty-six percent were classified as Child-Pugh B or C and 85% had an Eastern Cooperative Oncology Group performance status of 1–2. After SBRT, 86% of patients experienced no or mild treatment-related adverse events. Only 8% of patients experienced grade 3 and 2% of patients experienced grade 4 adverse events. Overall radiographic response was complete in 1.2%, partial in 35.4%, stable in 43.9%, and progressive disease in 19.5%. Median OS was 8.8 months with 1-, 2-, and 3-year OS rates of 38.0, 29.8 and 21.2%, respectively. The Cancer of the Liver Italian Program (CLIP) score was found to strongly correlate with survival. Median OS for patients with CLIP scores of 0, 1, 2, and 3 was 21.1, 8.5, 5.1, and 7.1 months, respectively ( p  = 0.003). Conclusion Our series demonstrates that SBRT is generally safe for HCC patients, even those with advanced liver failure. Although survival is generally poor, we were able to identify a group of patients with good liver function and early tumor stage who can achieve median OS of close to 2 years with SBRT.