Abstract
BackgroundRecent studies using stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) have reported high tumor response and local control. However, the optimal SBRT dose remains unknown, and it is still not clear whether a dose response relationship for local control (LC) and overall survival (OS) exist or not. We performed this study to determine whether a dose response relationship for LC and OS is observed in SBRT for inoperable HCC.MethodsBetween 2003 and 2011, 108 patients with HCC were treated with SBRT. All patients were unsuitable for surgery or local ablation and had incomplete response to transarterial chemoembolization. Eighty-two patients with a longest tumor diameter (LD) less than or equal to 7.0 cm who were treated with 3-fraction SBRT and were analyzed. This cohort comprised 74 Child-Turcotte-Pugh (CTP) class A patients and 8 CTP class B7 patients. The median LD was 3.0 cm (range, 1.0–7.0 cm), and the median dose was 51 Gy (range, 33–60 Gy).ResultsLC and OS rates at 2 years after SBRT were 87% and 63%, respectively, with a median follow-up duration of 30 months for all patients. The 2-year LC/OS rates for patients treated with doses of > 54, 45–54, and < 45 Gy were 100/71, 78/64, and 64%/30%, respectively (p = .009/p < .001). Multivariate analysis revealed that the SBRT dose (p = .005) and Barcelona Clinic Liver Cancer stage (p = .015) were significant prognostic factors for OS. Correlation analysis revealed a positive linear relationship between the SBRT dose and LC (p = .006, R = .899)/OS (p = .002, R = .940) at 2 years. Based on the tumor-control probability model, a dose of 54.8 Gy provides 2-year LC with a 90% probability. Five patients experienced grade 3 or higher gastrointestinal toxicity, and 6 had deteriorating of CTP score by greater than or equal to 2 within 3 months of SBRT.ConclusionsThis study demonstrated a dose response relationship for LC and OS with SBRT for HCC. Higher LC rates resulting from an increased dose may translate into survival benefits for patients with HCC.
Highlights
Recent studies using stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) have reported high tumor response and local control
We previously reported our results from phase I and II trials of SBRT for HCC and observed high local control (LC) rates and low severe toxicity rates [25,26]
The 2-year LC rates for lesions treated with doses of > 54, 45–54, and < 45 Gy were 100, 78, and 64%, respectively (p = 0.009) Figure 1(b))
Summary
Recent studies using stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) have reported high tumor response and local control. We performed this study to determine whether a dose response relationship for LC and OS is observed in SBRT for inoperable HCC. The treatment of choice for hepatocellular carcinoma (HCC) is surgery, but less than 20% of patients are suitable for surgery [2,3,4,5]. For patients with inoperable HCC, radiofrequency ablation (RFA) and other ablative therapies achieve excellent local control (LC) for small tumors. Radiotherapy (RT) has typically not been considered a frontline treatment for HCC due to the lower tolerance of the whole liver to RT [10]. Some recent studies reported favorable outcomes for three-dimensional conformal radiotherapy (3D-CRT) for HCC [11,12,13,14]
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