Role of stereotactic body radiation therapy in patients with hepatocellular carcinoma extensively pretreated with transarterial chemoembolization or yttrium-90.

Abstract

233 Background: Hepatocellular carcinoma (HCC) is an aggressive disease with dismal outcomes. Patients who are not surgical candidates are routinely treated with local therapies such as TACE, Y90, or SRBT among others. The study aimed to assess treatment response and treatment related toxicity to SBRT in patients who received prior TACE or Y90 at our institution, some of whom subsequently underwent orthotopic liver transplantation. Methods: IRB approval was obtained to retrospectively review 26 medical records of patients who received SBRT at the Loyola University Medical Center from 9/9/14-12/28/16. GI toxicities were analyzed using the Common Terminology Criteria for Adverse Events (CTAE) version 4.0 following SBRT. Skin, pharyngeal/esophageal, thorax, lung, GU, and GI toxicities were included in toxicity analysis. Patients received radiation dose from 36 Gy - 50 Gy in 5 fractions using RTOG 1112 dose constraints for dosimetric plan evaluation. Fisher’s exact tests and Wilcoxon Rank Sum tests were used for statistical analysis. Results: Of the 26 patients, 21 patients had prior TACE (median 3 TACE procedures; ranging from 1-5). 6 patients had prior Y90 with or without prior TACE. Median follow up for the cohort was 51 weeks. No patient showed GI toxicities above grade 1 during SBRT, with fatigue and nausea being the most common. One patient who previously received Y90 developed fatal duodenal perforation. Pathology demonstrated this was related to tumor infiltration of the duodenum and was not related to post radiation necrosis. 6 patients went on to undergo OLT with all patients having treatment response on surgical pathology with 4 patients having complete treatment response. Conclusions: SBRT was shown to safely treat patients after prior therapies including Y90 and TACE. Furthermore, SBRT showed favorable outcomes in post-OLT patients. To our knowledge, this is the first study to assess the effects of SBRT following extensive local therapies for HCC including Y90. Prospective data is needed to evaluate these findings further with longer follow up.