Abstract
Liver SBRT is a therapeutic option for the treatment of HCC in patients not eligible for other local therapies. We retrospectively report the outcomes of a cohort of consecutive patients treated with SBRT for HCC at the Montpellier Cancer Institute. Between March 2013 and December 2018, 66 patients were treated with image-guided liver SBRT using VMAT and real-time adaptive tumor gating in our institute. The main endpoints considered in this study were local control, disease-free survival, overall survival, and toxicity. The median follow-up was 16.8 months. About 66.7% had prior liver treatment. Most patients received 50 Gy in five fractions of 10 Gy. No patient had local recurrence. Overall survival and disease-free survival were, respectively, 83.9% and 46.7% at one year. In multivariate analysis, the diameter of the lesions was a significant prognostic factor associated with disease-free survival (HR = 2.57 (1.19-5.53) p = 0.02). Regarding overall survival, the volume of PTV was associated with lower overall survival (HR = 2.84 (1.14-7.08) p = 0.025). No grade 3 toxicity was observed. One patient developed a grade 4 gastric ulcer, despite the dose constraints being respected. Image-guided liver SBRT with VMAT is an effective and safe treatment in patients with inoperable HCC, even in heavily pre-treated patients. Further prospective evaluation will help to clarify the role of SBRT in the management of HCC patients.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world with an incidence of 854,000 new cases/year
The liver stereotactic body radiation therapy (SBRT) treatment was reviewed in multidisciplinary specialized tumor board with a liver surgeon, a hepatologist, a radiation oncologist, an oncologist specialized in digestive cancers, and a radiologist
The Barcelona clinic liver cancer (BCLC) score was predominantly 2 (n = 35), and the disease remained localized in 87% of patients
Summary
Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world with an incidence of 854,000 new cases/year. The majority of patients are not eligible for curative treatment In this case, trans arterial chemo embolization (TACE) is often performed in patients with preserved hepatic function, without extrahepatic invasion, or without ascites or portal thrombosis. Various Asian guidelines and NCCN guidelines have added contents about SBRT to integrate this therapeutic option as an alternative to other local treatments for HCC patients [10,11,12,13]. With the improvement of the precision of current techniques, in particular conformational radiotherapy allowing partial irradiation of the liver and SBRT allowing the delivery of high doses of radiation in small volumes, toxicities were reduced with less than 5% of RILD [16,17].
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 call
