Outcomes after Stereotactic Body Radiation for Hepatocellular Carcinoma in Patients with Childs Pugh A vs. Childs Pugh B/C Cirrhosis

Abstract

<h3>Purpose/Objective(s)</h3> Stereotactic body radiation therapy (SBRT) has been shown to be a safe and effective local treatment for hepatocellular carcinoma (HCC). However, limited data exist in patients with CP B and C cirrhosis. The purpose of our study was to compare local control (LC), overall survival (OS), and toxicity outcomes for patients with CP A versus CP B and C cirrhosis. We hypothesized that CP B and C patients would have poorer overall survival, increased toxicity, and similar local control. <h3>Materials/Methods</h3> Patients with HCC who were treated with SBRT were prospectively enrolled into our institutional database from 2012-2021. Patients were separated into cohorts based on their liver function to generate a CP A and CP B/C cohort. LC and OS were evaluated using the Kaplan-Meier method. Local control was evaluated using both radiographic and pathologic data when available. <h3>Results</h3> 78 patients with a total of 94 tumors were included in our analysis with a median follow up of 23.6 months. Median tumor size was 3.6 cm. Median dose delivered was 47.5 Gy in a median of 5 fractions. There were 50 (64%) CP A and 28 (36%) CP B/C patients. The cohorts were comparable in terms of tumor size and baseline AFP. The mean EQD2 was significantly greater in the CP A cohort 85.47 Gy compared to the CP B/C cohort 57.14 Gy (<i>p</i> < .01) Furthermore, a greater proportion of CP B/C patients (64% 18/28) were listed for orthotopic liver transplant compared to CP A patients (30% 15/50) (<i>p</i> =0.004). The estimated 1-year LC rate were similar between the two cohorts with 92.5% LC in the CP A group and 90.9% LC in the CP B/C group (<i>p</i> =0.554). OS was not statistically different between cohorts with an estimated 1-year OS of 85.4% in the CP A group and 60% in the CP B/C group (<i>p</i> =0.225). Radiographic complete response (rCR) was comparable for CP A and CP B/C cohorts at 74% (42/57) and 63% (17/27) respectively. Of the tumors that were pathologically analyzed (CP A n=19; CP B/C n=13), the CP A and CP B/C cohorts had similar pathologic complete response rates of 63% and 62% respectively. 24 (41%) CP A patients and 14 (40%) CP B/C patients developed elsewhere liver tumor recurrence. 9 (15%) CP A patients and 3 (9%) CP B/C patients developed distant metastatic disease. Toxicity rates were low with only 3 patients (6%) in the CP A cohort and 6 patients (21%) in the CP B/C cohort that had grade 3+ adverse events. CP progression occurred in 16% of the CP A group and 29% of the CP B/C group. <h3>Conclusion</h3> Despite receiving lower radiation doses, CP B/C patients had similar LC and pCR rates when compared to CP A patients. OS was not statistically different between the cohorts but analysis was limited due to small numbers and higher number of liver transplant patients in the CP B/C group could also be confounding this result. Although the toxicity rate was reasonable, grade 3+ adverse events and CP progression were higher in CP B/C patients compared to CP A patients.