Managing hepatocellular carcinoma across the stages: efficacy and outcomes of stereotactic body radiotherapy : Aretrospective study.

Abstract

Hepatocellular carcinoma (HCC) poses aunique challenge due to its predilection for developing on compromised livers, often limiting surgical options. Stereotactic body radiotherapy (SBRT) has emerged as apromising local treatment modality for HCC. This study aims to assess the effectiveness of SBRT in HCC patients not suitable for surgery, focusing on local control, optimal radiation dosing, and prognostic factors. In this retrospective analysis, 52 HCC patients treated with SBRT were examined. The study assessed local control, progression-free survival (PFS), and overall survival (OS) while conducting dosimetric analyses. The relationship between mean liver dose and Child-Pugh score (CPS) progression was also explored. SBRT demonstrated 93.4% freedom from local progression (FFLP) at 12months. Notably, anear minimum dose (D98%) below 61 Gy as an equivalent dose in 2‑Gy fractions with α/β 10 Gy (EQD2α/β10) was associated with reduced FFLP (p-value 0.034). Logistic regression analysis revealed adose-response relationship for FFLP and D98% with 95% and 98% probability of FFLP at adose of 56.9 and 73.1 Gy, respectively. The study observed OS rates of 63.7% at 1year and 34.3% at 3years. Patients with portal vein tumor thrombus (PVTT) and larger tumors (≥ 37 cm3) experienced decreased PFS and OS. Multivariate analysis identified PVTT, larger tumor volume, and performance status as independent predictors of reduced OS. Notably, classical radiation-induced disease (cRILD) was absent, but nonclassical (nc) RILD occurred in 7.7% of patients. Regression analysis linked amean EQD2α/β3-8 dose to the liver (12.8-12.6) with a10% likelihood of ncRILD. SBRT offers acompelling option for achieving high local control and promising survival outcomes in HCC. The study supports aradiation dose range of 61-73.1 Gy, coupled with amean liver dose under 12.6-12.8 Gy as EQD2, to achieve favorable FFLP rates, with acceptable toxicity rates.