Abstract
ObjectiveTo evaluate the survival outcomes and prognostic factors of patients with advanced hepatocellular carcinoma (HCC) who underwent stereotactic ablative radiotherapy (SABR).MethodsThis retrospective study evaluated patients with advanced HCC who underwent SABR between December 2007 and July 2015. All patients had Barcelona Clinic Liver Cancer stage C disease and Child–Turcotte–Pugh (CTP) class A–B function. In-field control (IFC), overall survival (OS), prognostic factors, and toxicity were evaluated.ResultsIn this study of 89 patients, the 3-year IFC rate was 78.1%, and the 1-year and 3-year OS rates were 45.9% and 24.3%, respectively. The multivariate analysis revealed that CTP class, the presence of main portal vein tumor thrombosis, and the presence of extrahepatic spread were independent predictors of OS. The expected median OS values among patients with ≥2, 1, and 0 predictors were 4.2, 8.6, and 26.4 months, respectively (p <0.001).ConclusionsSABR may be useful for patients with advanced HCC, and patient selection could be based on the CTP classification, main portal vein tumor thrombosis, and extrahepatic spread.
Highlights
Hepatocellular carcinoma (HCC) is a common cause of cancer mortality [1]
stereotactic ablative radiotherapy (SABR) may be useful for patients with advanced HCC, and patient selection could be based on the CTP classification, main portal vein tumor thrombosis, and extrahepatic spread
Before SABR, most patients had underlying viral hepatitis predominantly related to hepatitis B virus [HBV] infection (46 patients, 51.7%), CTP class A liver function (69 patients, 77.5%), and American Joint Committee on Cancer stage of !III (69 patients, 77.5%)
Summary
The high mortality rate is partly attributed to the fact that many patients with newly diagnosed HCC have advanced disease, and approximately 30–40% have Barcelona Clinic Liver Cancer (BCLC) stage C disease [2, 3] In this context, BCLC stage C HCC represents a disease spectrum characterized by a cancer-related Eastern Cooperative Group (ECOG) performance status of 1–2, macrovascular invasion, and/or extrahepatic spread (ES) [4]. BCLC stage C HCC represents a disease spectrum characterized by a cancer-related Eastern Cooperative Group (ECOG) performance status of 1–2, macrovascular invasion, and/or extrahepatic spread (ES) [4] Patients in this subgroup have a poor prognosis, and treatment is generally palliative; currently, sorafenib monotherapy is the standard treatment, based on available randomized studies and BCLC systems [4,5,6,7]. Local treatment modalities that can improve therapeutic responses and survival are needed
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