SBRT and Hyperthermia in Hepatocellular Carcinoma - Tertiary Cancer Centre Experience

Abstract

Stereotactic Body Radiotherapy (SBRT) has emerged as an effective modality for managing primary and secondary hepatocellular carcinoma (HCC). This modality is seen to be useful as primary therapy and in some circumstances as a bridging therapy to transplant. Hyperthermia, the procedure of raising the temperature of tumor tissue to 40-43 degrees centigrade, is applied as an adjunctive therapy with various established cancer treatments such as radiotherapy and chemotherapy. The objective of this study was to evaluate the efficacy of combining hyperthermia and SBRT in HCC patients. A retrospective analysis of 14 patients who underwent combine modality treatment with SBRT and Hyperthermia between 2009 and 2019 was undertaken. SBRT was given by robotic radiosurgery to gross tumor volume (GTV) of Liver with a dose of 30-40Gy in 5 fractions. Hyperthermia was given for all patients in 3 sessions on alternate days as a sandwich technique 20 minutes before and after SBRT. PET-CT response and biochemical response was evaluated. if the 14 patients, median age was found to be 59 years (range 30-76) and 13 were males. The size of the lesions treated ranged from 2.8cm to 14cm. Child Pugh A category had 7 patients while 6 and 1 patients were in Child Pugh B and C category respectively. More than 50% reduction of Alpha Fetoprotein (AFP) was found in all patients. Median reduction in tumor size in follow up pet scans was 22%. All patients had partial reduction of tumor size except one patient who had increase in size from 7 to 8.7cm. There was also a partial reduction of PET SUV. Combined hyperthermia and SBRT is safe and effective in reducing the tumor size and well tolerated in HCC patients. Validation of this technique is required by more systematic study designs.