Abstract
BackgroundTo assess the significance of alpha-fetoprotein (AFP) normalization as a prognostic surrogate after stereotactic body radiotherapy (SBRT) for patients with small hepatocellular carcinoma (HCC).MethodsPatients who underwent SBRT for primary or recurrent HCC were registered and a database thereof was retrospectively reviewed. Among 165 total registered patients, 77 patients were selected who satisfied the following criteria: (1) their AFP levels were > 20 ng/mL before SBRT, and (2) their AFP levels were checked within three months after SBRT. Propensity score based matching analysis was performed to minimize potential confounding bias. AFP normalization was defined as a reduction of AFP level to ≤ 20 ng/mL. Overall survival (OS) and progression-free survival (PFS) curves were estimated by the Kaplan-Meier method.ResultsThirty-seven (48.1 %) patients displayed AFP normalization (normalized group), while 40 (51.9 %) patients comprised the non-normalized group. The OS rates at 3-year were 62.0 % and 44.0 % (p = 0.023), and the PFS rates at 3-year were 27.9 % and 12.0 % (p = 0.019), in the normalized and non-normalized groups, respectively. Local control rates were 97.2 % in the normalized group and 94.7 % in the non-normalized group at three years (p = 0.579). In the propensity score matching cohort (25 pairs), OS and PFS were significantly longer in the normalized group than in the non-normalized group (p = 0.017 and 0.049, respectively). The local control rates were 100 % in both matched groups.ConclusionsAFP normalization within three months after SBRT is a prognostic surrogate for OS and PFS in patients with small HCC. AFP monitoring should be considered a useful tool for HCC patients with an elevated AFP level before SBRT.
Highlights
To assess the significance of alpha-fetoprotein (AFP) normalization as a prognostic surrogate after stereotactic body radiotherapy (SBRT) for patients with small hepatocellular carcinoma (HCC)
Gross tumor volume (GTV) was delineated based on visible gross tumor seen on computed tomography (CT) images at the end-expiratory phase; extension based on movement within the gating phase (30–70 %) from the GTV was set as the internal target volume (ITV)
This study demonstrated that overall survival (OS) and progression-free survival (PFS) were longer in AFP responders after concurrent chemoradiotherapy (CCRT)
Summary
To assess the significance of alpha-fetoprotein (AFP) normalization as a prognostic surrogate after stereotactic body radiotherapy (SBRT) for patients with small hepatocellular carcinoma (HCC). Surgical resection and liver transplantation are curative treatment modalities for HCC. Surgical resection has shown overall survival (OS) and recurrence-free survival rates of 75–85 % and 83–92 %, respectively, at 3–4 years [1, 2]. Liver transplantation has shown a five-year OS rate of 70 %, as well as a low recurrence rate [1, 3]. Only a small proportion of patients can be treated using these modalities for various clinical reasons. Another curative treatment of HCC is radiofrequency ablation (RFA), which yields a necrosis rate of 90–100 % for tumors < 2 cm in diameter and 50 % for those with a diameter > 3 cm [4, 5]. An alternative local therapeutic modality, namely stereotactic radiotherapy, is urgently needed in these clinical settings
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
