Abstract
PurposeStereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) has been evaluated in several recent studies. The CyberKnife® is an SBRT system that allows for real-time tracking of the tumor. The purpose of this study was to evaluate the prognostic factors for local control and overall survival following this treatment.Patients and Methods75 patients with 96 liver-confined HCC were treated with SBRT at the Oscar Lambret Comprehensive Cancer Center. Fiducials were implanted in the liver before treatment and were used as markers to track the lesion’s movement. Treatment response was scored according to RECIST v1.1. Local control and overall survival were calculated using the Kaplan and Meier method. A stepwise multivariate analysis (Cox regression) of prognostic factors was performed for local control and overall survival.ResultsThere were 67 patients with Child-Turcotte-Pugh (CTP) Class A and eight patients with CTP Class B. Treatment was administered in three sessions. A total dose of 40–45 Gy to the 80% isodose line was delivered. The median follow-up was 10 months (range, 3–49 months). The local control rate was 89.8% at 1 and 2 years. Overall survival was 78.5% and 50.4% at 1 and 2 years, respectively. Toxicity mainly consisted of grade 1 and grade 2 events. Higher alpha-fetoprotein (aFP) levels were associated with less favorable local control (HR=1.001; 95% CI [1.000, 1.002]; p=0.0063). A higher dose was associated with better local control (HR=0.866; 95% CI [0.753, 0.996]; p=0.0441). A Child-Pugh score higher than 5 was associated with worse overall survival (HR= 3.413; 95% CI [1.235, 9.435]; p=0.018).ConclusionSBRT affords good local tumor control and higher overall survival rates than other historical controls (best supportive care or sorafenib). High aFP levels were associated with lesser local control, but a higher treatment dose improved local control.
Highlights
Hepatocellular carcinoma (HCC) has become one of the leading causes of death in cirrhotic patients [1]
This study reports the results of Stereotactic body radiotherapy (SBRT) in an updated and expanded population of patients treated for hepatocellular carcinoma only
The patients included in the study had HCC, an Eastern Cooperative Oncology Group (ECOG) performance score of less or equal to 2, pre-treatment Child-Turcotte-Pugh (CTP) (Table 1) scores A5–B8, and ineligibility for surgical resection, transarterial chemoembolization (TACE), radiofrequency ablation (RFA), or sorafenib
Summary
Hepatocellular carcinoma (HCC) has become one of the leading causes of death in cirrhotic patients [1]. Liver function and patient general condition are the main prognostic factors in HCC. Surgery is the standard of care for these patients, but only 10–30% of patients are eligible for this treatment. When surgery is not possible, therapeutic options include percutaneous alcohol injection, radiofrequency ablation (RFA) [3] and transarterial chemoembolization (TACE) [4]. When these options are not feasible, recommendations include best supportive care, sorafenib [5] or radiotherapy [6], performed alone or in combination [7]
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