Abstract
Background and aimTo evaluate the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients with unresectable huge hepatocellular carcinoma (HCC) unsuitable of other standard treatment option.MethodsBetween 2009 and 2011, 22 patients with unresectable huge HCC (≧10 cm) were treated with SBRT. dose ranged from 26 Gy to 40 Gy in five fractions. Overall survival (OS) and disease-progression free survival (DPFS) were determined by Kaplan-Meier analysis. Tumor response and toxicities were also assessed.ResultsAfter a median follow-up of 11.5 month (range 2–46 months). The objective response rate was achieved in 86.3% (complete response (CR): 22.7% and partial response (PR): 63.6%). The 1-yr. local control rate was 55.56%. The 1-year OS was 50% and median survival was 11 months (range 2–46 months). In univariate analysis, Child-Pugh stage (p = 0.0056) and SBRT dose (p = 0.0017) were significant factors for survival. However, in multivariate analysis, SBRT dose (p = 0.0072) was the most significant factor, while Child-Pugh stage of borderline significance. (p = 0.0514). Acute toxicities were mild and well tolerated.ConclusionThis study showed that SBRT can be delivered safely to huge HCC and achieved a substantial tumor regression and survival. The results suggest this technique should be considered a salvage treatment. However, local and regional recurrence remain the major cause of failure. Further studies of combination of SBRT and other treatment modalities may be reasonable.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common malignancy worldwide, and the leading cause of cancer death in South and East Asia
Tumor response and local control The tumor response was based on the change in the maximum tumor size on serial computed tomography (CT)-scans or magnetic resonance imaging (MRI) 4–8 weeks after completion of treatment and 2- to 3- months thereafter
After a median follow-up of 11.5 month, an objective response was achieved in 19 patients (86.3%), with complete response in 5 patients (22.7%), partial response in 14 patients (63.6%), and stable disease in 3 patients (13.6%) (Table 2)
Summary
Hepatocellular carcinoma (HCC) is one of the most common malignancy worldwide, and the leading cause of cancer death in South and East Asia. In small HCC, hepatic resection and other nonsurgical treatment modalities have contributed to good survival [1,2]. Treatment for huge HCC (≧ 10 cm in diameter) remain a challenge. For unresectable huge HCC, TACE is an alternative, but the response rates are generally poor for large tumors [8,9]. After failure of TACE or patients unsuitable for TACE due to co-existing morbidities such as portal vein thrombosis or other vascular extension, no standard treatment is available, and various clinical trial have been tried, but to date survival benefits have been limited. To evaluate the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients with unresectable huge hepatocellular carcinoma (HCC) unsuitable of other standard treatment option
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