Stereotactic Ablative Body Radiation Therapy for Previously Untreated Solitary Hepatocellular Carcinoma in Patients With Liver Disease

Abstract

Purpose/Objective(s)We retrospectively evaluated outcomes of stereotactic ablative body radiation therapy (SABR) for previously untreated solitary hepatocellular carcinoma (us-HCC) unfit for ablation therapy and resection in patients with underlying liver disease.Materials/MethodsBetween 2005 and 2012, 237 patients with HCC were treated with SABR with curative intent. Among them, patients with us-HCC, treated with only SABR or SABR preceded by transarterial chemoembolization (TACE) within 3 months and with a potential follow-up >6 months were eligible. Based on baseline liver function and irradiated liver volume and dose, 35-40 Gy in 5 fractions was prescribed to the 70-80% isodose line of the maximum dose covering the planning target volume. Treatment outcome and toxicities were analyzed.ResultsSixty-three patients were eligible, with a median follow-up duration of 24.4 months (range; 3.3-79.4 months). Twenty patients were treated with only SABR. In 43 patients treated with SABR preceded by TACE, accumulation of lipiodol in the tumor remained full in 5, was more than half with a partial defect in 16, was less than half in 17 and did not occur in 5 on pre-SABR evaluation CT. The 1-, 2- and 3-year local control rates were 100%, 97.1% and 93.0%, respectively. The intrahepatic recurrence-free rates were 80.1%, 57.6% and 31.3%, respectively. The overall survival rates were 100%, 93.4% and 81.5%, respectively. Grade 3 laboratory toxicities were observed in 18 patients and ascites occurred in one patient.ConclusionsLocal control and overall survival after SABR for us-HCC were excellent despite the candidates being unfit for resection and ablation therapy. SABR is safe and might be an alternative to resection and ablation therapy. Further prospective studies are warranted to validate the effect of SABR for HCC. Purpose/Objective(s)We retrospectively evaluated outcomes of stereotactic ablative body radiation therapy (SABR) for previously untreated solitary hepatocellular carcinoma (us-HCC) unfit for ablation therapy and resection in patients with underlying liver disease. We retrospectively evaluated outcomes of stereotactic ablative body radiation therapy (SABR) for previously untreated solitary hepatocellular carcinoma (us-HCC) unfit for ablation therapy and resection in patients with underlying liver disease. Materials/MethodsBetween 2005 and 2012, 237 patients with HCC were treated with SABR with curative intent. Among them, patients with us-HCC, treated with only SABR or SABR preceded by transarterial chemoembolization (TACE) within 3 months and with a potential follow-up >6 months were eligible. Based on baseline liver function and irradiated liver volume and dose, 35-40 Gy in 5 fractions was prescribed to the 70-80% isodose line of the maximum dose covering the planning target volume. Treatment outcome and toxicities were analyzed. Between 2005 and 2012, 237 patients with HCC were treated with SABR with curative intent. Among them, patients with us-HCC, treated with only SABR or SABR preceded by transarterial chemoembolization (TACE) within 3 months and with a potential follow-up >6 months were eligible. Based on baseline liver function and irradiated liver volume and dose, 35-40 Gy in 5 fractions was prescribed to the 70-80% isodose line of the maximum dose covering the planning target volume. Treatment outcome and toxicities were analyzed. ResultsSixty-three patients were eligible, with a median follow-up duration of 24.4 months (range; 3.3-79.4 months). Twenty patients were treated with only SABR. In 43 patients treated with SABR preceded by TACE, accumulation of lipiodol in the tumor remained full in 5, was more than half with a partial defect in 16, was less than half in 17 and did not occur in 5 on pre-SABR evaluation CT. The 1-, 2- and 3-year local control rates were 100%, 97.1% and 93.0%, respectively. The intrahepatic recurrence-free rates were 80.1%, 57.6% and 31.3%, respectively. The overall survival rates were 100%, 93.4% and 81.5%, respectively. Grade 3 laboratory toxicities were observed in 18 patients and ascites occurred in one patient. Sixty-three patients were eligible, with a median follow-up duration of 24.4 months (range; 3.3-79.4 months). Twenty patients were treated with only SABR. In 43 patients treated with SABR preceded by TACE, accumulation of lipiodol in the tumor remained full in 5, was more than half with a partial defect in 16, was less than half in 17 and did not occur in 5 on pre-SABR evaluation CT. The 1-, 2- and 3-year local control rates were 100%, 97.1% and 93.0%, respectively. The intrahepatic recurrence-free rates were 80.1%, 57.6% and 31.3%, respectively. The overall survival rates were 100%, 93.4% and 81.5%, respectively. Grade 3 laboratory toxicities were observed in 18 patients and ascites occurred in one patient. ConclusionsLocal control and overall survival after SABR for us-HCC were excellent despite the candidates being unfit for resection and ablation therapy. SABR is safe and might be an alternative to resection and ablation therapy. Further prospective studies are warranted to validate the effect of SABR for HCC. Local control and overall survival after SABR for us-HCC were excellent despite the candidates being unfit for resection and ablation therapy. SABR is safe and might be an alternative to resection and ablation therapy. Further prospective studies are warranted to validate the effect of SABR for HCC.