Abstract
BackgroundThe objectives of this retrospective study was to evaluate the efficacy of stereotactic body radiation therapy (SBRT) for small non-resectable hepatocellular carcinoma (HCC) and SBRT combined with transarterial chemoembolization (TACE) for advanced HCC with portal vein tumor thrombosis (PVTT).MethodsThirty one patients with HCC who were treated with SBRT were used for the study. We studied 32 HCC lesions, where 23 lesions (22 patients) were treated targeting small non-resectable primary HCC, and 9 lesions (9 patients) targeting PVTT using the Cyberknife. All the 9 patients targeting PVTT received TACE for the advanced HCC. Tumor volume was 3.6–57.3 cc (median, 25.2 cc) and SBRT dose was 30–39 Gy (median, 36 Gy) in 3 fractions for consecutive days for 70–85% of the planned target volume.ResultsThe median follow up was 10.5 months. The overall response rate was 71.9% [small HCC: 82.6% (19/23), advanced HCC with PVTT: 44.4% (4/9)], with the complete and partial response rates of 31.3% [small HCC: 26.1% (6/23), advanced HCC with PVTT: 11.1% (1/9)], and 50.0% [small HCC: 56.5% (13/23), advanced HCC with PVTT: 33.3% (3/9)], respectively. The median survival period of small HCC and advanced HCC with PVTT patients was 12 months and 8 months, respectively. No patient experienced Grade 4 toxicity.ConclusionSBRT for small HCC and SBRT combined with TACE for advanced HCC with PVTT showed feasible treatment modalities with minimal side effects in selected patients with primary HCC.
Highlights
The objectives of this retrospective study was to evaluate the efficacy of stereotactic body radiation therapy (SBRT) for small non-resectable hepatocellular carcinoma (HCC) and SBRT combined with transarterial chemoembolization (TACE) for advanced HCC with portal vein tumor thrombosis (PVTT)
We treated 32 HCC lesions with the Cyberknife (Accuray Inc, Sunnyvale, CA) SBRT: 23 lesions (22 patients) of small non-resectable primary HCC were treated by SBRT while 9 lesions (9 patients) of PVTT in advanced HCCs were treated by SBRT combined with TACE
The criteria for patients to be included in the study were as follows: (1) patients with histologically proven primary HCC by ultrasound guided percutaneous needle biopsy of liver, (2) patients with active, enhancing HCC by radiography, (3) patients with PVTT surrounding near the HCC, not located at the distant, separate parenchyma, (4) patients not showing extrahepatic metastases, (5) patients with tumor size ≤ 5 cm, (6) age < 75, (7) patients with HCC that did not develop within the transplanted liver, (8) patients who had ECOG
Summary
The objectives of this retrospective study was to evaluate the efficacy of stereotactic body radiation therapy (SBRT) for small non-resectable hepatocellular carcinoma (HCC) and SBRT combined with transarterial chemoembolization (TACE) for advanced HCC with portal vein tumor thrombosis (PVTT). Primary hepatocellular carcinoma (HCC), which comprises 90% of all malignant cancers developed in the liver, is a fatal disease that might cause death with severe complications unless treated properly [1,2]. Many modalities such as surgical resection, percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), Y90 microspheres, external radiation therapy (RT) and transarterial chemoembolization (TACE) have been tried in the treatment for HCC [3,4,5,6,7,8], but the optimal treatment approach remains controversial. We performed LINAC-based SBRT for 20 primary HCC patients with the result of 80% local control, confirming that SBRT is helpful in the treating primary HCC
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