Abstract
BackgroundThe optimal dose and fractionation scheme of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) remains unclear due to different tolerated liver volumes and degrees of cirrhosis. In this study, we aimed to verify the dose-survival relationship to optimize dose selection for treatment of HCC.MethodsThis multicenter retrospective study included 602 patients with HCC, treated with SBRT between January 2011 and March 2017. The SBRT dosage was classified into high dose, moderate dose, and low dose levels: SaRT (BED10 ≥ 100 Gy), SbRT (EQD2 > 74 Gy to BED10 < 100 Gy), and ScRT (EQD2 < 74 Gy). Overall survival (OS), progression-free survival (PFS), local control (LC), and intrahepatic control (IC) were evaluated in univariable and multivariable analyses.ResultsThe median tumor size was 5.6 cm (interquartile range [IQR] 1.1–21.0 cm). The median follow-up time was 50.0 months (IQR 6–100 months). High radiotherapy dose correlated with better outcomes. After classifying into the SaRT, SbRT, and ScRT groups, three notably different curves were obtained for long-term post-SBRT survival and intrahepatic control. On multivariate analysis, higher radiation dose was associated with improved OS, PFS, and intrahepatic control.ConclusionsIf tolerated by normal tissue, we recommend SaRT (BED10 ≥ 100 Gy) as a first-line ablative dose or SbRT (EQD2 ≥ 74 Gy) as a second-line radical dose. Otherwise, ScRT (EQD2 < 74 Gy) is recommended as palliative irradiation.
Highlights
The optimal dose and fractionation scheme of stereotactic body radiation therapy (SBRT) for hepa‐ tocellular carcinoma (HCC) remains unclear due to different tolerated liver volumes and degrees of cirrhosis
In a previous retrospective study of SBRT for 127 patients with HCCs that were > 5 cm, we preliminarily found that higher biologically effective dose (BED10) and equivalent dose in 2 Gy fractions (EQD2) was associated with better survival [22]
When RT dose was used to classify the patients into the SaRT, SbRT, and ScRT groups, 3 notably different curves were observed for long-term post-SBRT survival
Summary
The optimal dose and fractionation scheme of stereotactic body radiation therapy (SBRT) for hepa‐ tocellular carcinoma (HCC) remains unclear due to different tolerated liver volumes and degrees of cirrhosis. The use of external beam radiation therapy (RT) [3], including stereotactic body radiation therapy (SBRT), is increasing in popularity of treatment for HCC [4,5,6,7,8,9,10,11] It is commonly recommended as an alternative treatment in medically inoperable patients, as a result of its rapid adoption in clinical practice worldwide [12,13,14]. In a previous retrospective study of SBRT for 127 patients with HCCs that were > 5 cm, we preliminarily found that higher biologically effective dose (BED10) and equivalent dose in 2 Gy fractions (EQD2) was associated with better survival [22]. We aimed to verify the dose-survival relationship to optimize dose selection for treatment of HCC
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