Safety of Liver Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma following Transarterial Radioembolization vs. Transarterial Chemoembolization

Abstract

With increasing use of high dose transarterial radioembolization (TARE) and stereotactic body radiation therapy (SBRT) for the treatment of hepatocellular carcinoma (HCC), there is concern for radiation related complications to the liver when using SBRT after TARE. This study examines safety of SBRT following TARE in comparison to SBRT following transarterial chemoembolization (TACE). A single institution retrospective chart review identified patients who received SBRT following TACE or TARE for HCC in the period 2012-2016. TARE was delivered using Y90, administered transarterially with dose adjusted based on macroaggregated albumin (MAA) imaging. SBRT was delivered in 5 fractions. Patients were analyzed for Child-Turcott-Pugh score (CTP), Albumin-Bilirubin (ALBI) score, and Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grade ≥ 3 events, and compared between cohorts with Fisher’s exact text. Linear mixed models were used to estimate trends in CTP and ALBI scores over time within each treatment group and to compare trends between groups. One hundred four patients met criteria with median follow-up of 9.9 months (range, 0.3-48): 72 patients (69%) had SBRT post-TACE and 32 (31%) post-TARE. The groups were well balanced with regard to sex, etiology of HCC, number of prior liver-directed therapies, baseline mean CTP and ALBI scores, and SBRT dose (median 40 Gy). There was a significant difference in baseline ECOG performance status (p=0.006) and median follow-up: 10.3 months post-TACE vs. 6.4 months post-Y90 (p=0.006). There were 6 ≥ grade 3 acute toxicities in the post-TACE group and 1 in the post-TARE (p=0.43). Toxicities included hepatic failure (n=2), ascites (n=2), hyperbilirubinemia (n=1), GI bleed (n=1), and hydrothorax (n=1). There were no late (≥ 6 months) post-TARE events. Compared to baseline CTP and ALBI scores, there was a significant increase in the mean post-SBRT CTP and ALBI scores (p<0.0001) for both groups. However, there was no significant difference in rise in CTP (p=0.11) or ALBI scores (p=0.82) over time between SBRT post-TACE and post-TARE. The differences in CTP and ALBI scores over time between post-TACE and post-TARE (TACE minus TARE) are shown in Table 1. Reirradiation with SBRT following TARE for HCC appears to be safe and well tolerated compared to SBRT following chemoembolization with no significant increased risk of ≥ grade 3 toxicities or liver decompensation, as characterized by CTP or ALBI score. These data need to be further verified with longer follow-up and dosimetric analysis.Abstract SU_13_2129; Table 1CTP scoreALBI scoreDifference (95% CI)p-valueDifference (95% CI)p-valueBaseline-0.01 (-0.45, 0.43)0.96570.05 (-0.18, 0.27)0.67591 Mo-0.40 (-0.88, 0.09)0.1065-0.10 (-0.34, 0.15)0.43103 Mo-0.36 (-0.84, 0.13)0.15100.00 (-0.24, 0.25)0.97136 Mo0.11 (-0.42, 0.63)0.68150.11 (-0.15, 0.38)0.41099 Mo-0.24 (-0.86, 0.38)0.45030.07 (-0.25, 0.39)0.660212 Mo-0.78 (-1.49, -0.07)0.0323*-0.25 (-0.61, 0.12)0.1791 Open table in a new tab