Treatment Outcomes of Hepatocellular Carcinoma Patients who underwent Stereotactic Body Radiotherapy
Abstract
Objective: To evaluate the prognosis of patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiotherapy (SBRT).
Material and Methods: A retrospective review was performed of the institutional medical records of patients treated with SBRT. The selection criteria were as follows: unresectable HCC confirmed via pathologically, or through imaging, a Karnofsky Performance Status score >60, any Barcelona Clinic Liver Cancer stage, a Child-Pugh score ≤8, and an uninvolved liver volume >700 cm3 . The primary outcomes were local tumor control, overall survival, and progressionfree survival rates. The secondary outcomes were acute adverse events; including general, gastrointestinal, or hepatic disorders; decreased complete blood count; and increased liver function test results.
Results: We included 27 HCC patients treated with SBRT; from August 2013 to October 2019. Moreover, 55.6% of patients had received previous treatments for their SBRT-treated lesions. Additionally, the median volume of internal target volume was 40 cm3 , the median uninvolved liver volume was 1,162 cm3 , and the median radiation dose was 40 Gray: given in five fractions. The 1- and 2-year local tumor control rates were both 79.5%. The 1- and 2-year overall survival rates were 58.8% and 27.6%, respectively, and the median survival was 13 months. There were no grade 4 or 5 acute adverse events observed at initiation of treatment or during the follow-up period. Thirteen percent of patients experienced grade 3 acute adverse events. Three patients experienced radiation-induced liver disease.
Conclusion: SBRT can be an effective local treatment for hepatocellular carcinoma in carefully selected patients.
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Imsamran W. Cancer in Thailand Vol.IX, 2013-2015 [monograph on the Internet]. Bangkok: New Thammada Press; 2018. Available from: http://www.nci.go.th/th/File_download/Nci%20 Cancer%20Registry/In%20Cancer%20in%20Thailand %20IX%20OK.pdf
Omata M, Dan Y, Daniele B, Plentz R, Rudolph KL, Manns M, et al. Clinical features, etiology, and survival of hepatocellular carcinoma among different countries. J Gastroenterol Hepatol 2002;17(Suppl):S40-9.
Sithinamsuwan P. Review of 336 patients with hepatocellular carcinoma at Songklanagarind Hospital. World J Gastroenterol 2000;6:339.
Belghiti J, Kianmanesh R. Surgical treatment of hepatocellular carcinoma. HPB 2005;7:42–9.
Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatol Baltim Md 2003;37:429–42.
Jun BG, Kim SG, Kim YD, Cheon GJ, Han KH, Yoo JJ, et al. Combined therapy of transarterial chemoembolization and stereotactic body radiation therapy versus transarterial chemoembolization for ≤5cm hepatocellular carcinoma: propensity score matching analysis. PloS One 2018;13:e0206381.
Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008;359:378–90.
Bujold A, Massey CA, Kim JJ, Brierley J, Cho C, Wong RKS, et al. Sequential Phase I and II Trials of Stereotactic Body Radiotherapy for Locally Advanced Hepatocellular Carcinoma. J Clin Oncol 2013;31:1631–9.
Andolino DL, Johnson CS, Maluccio M, Kwo P, Tector AJ, Zook J, et al. Stereotactic body radiotherapy for primary hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2011;81:e447- 53.
Lasley FD, Mannina EM, Johnson CS, Perkins SM, Althouse S, Maluccio M, et al. Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy. Pract Radiat Oncol 2015;5:e443–9.
Lax I, Blomgren H, Näslund I, Svanström R. Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects. Acta Oncol Stockh Swed 1994;33:677–83.
Song CW, Glatstein E, Marks LB, Emami B, Grimm J, Sperduto PW, et al. Biological Principles of Stereotactic Body Radiation Therapy (SBRT) and Stereotactic Radiation Surgery (SRS): Indirect Cell Death. Int J Radiat Oncol Biol Phys 2021;110:21-34.
Yang JD, Roberts LR. Hepatocellular carcinoma: a global view. Nat Rev Gastroenterol Hepatol 2010;7:448–58.
Sooklim K, Sriplung H, Piratvisuth T. Histologic subtypes of hepatocellular carcinoma in the southern Thai population. Asian Pac J Cancer Prev APJCP 2003;4:302–6.
Tangkijvanich P, Hirsch P, Theamboonlers A, Nuchprayoon I, Poovorawan Y. Association of hepatitis viruses with hepatocellular carcinoma in Thailand. J Gastroenterol 1999;34:227–33.
Li H, Qin Y, Li X, Li Q. Comparison of prognosis of small hepatocellular carcinoma patients with hepatitis B virus infection versus hepatitis C virus infection. Zhonghua Gan Zang Bing Za Zhi Zhonghua Ganzangbing Zazhi Chin J Hepatol 2009;17:426–8.
Abbas Z, Siddiqui A-R, Luck NH, Hassan M, Mirza R, Naqvi A, et al. Prognostic factors of survival in patients with nonresectable hepatocellular carcinoma: hepatitis C versus miscellaneous etiology. JPMA J Pak Med Assoc 2008;58:602–7.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649–55.
Laura A. Dawson. Radiation Therapy Oncology Group RTOG 1112 Randomized phase III study of Sorafenib versus stereotactic body radiation therapy followed by Sorafenib in hepatocellular carcinoma [monograph on the Internet]. Philadelphia: RTOG foundation. Available from: https://www.rtog.org/Clinical Trials/ProtocolTable/StudyDetails.aspx?ptid=387&mode= broadcasts&page896=3&study=1112
Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010;30:52–60.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer Oxf Engl 1990;45:228–47.
Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 [monograph on the Internet]. Maryland: U.S. Department of Health and Human services; 2017. Available from: https://ctep.cancer.gov/protocoldevelopment/electronic_ applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf
Tse RV, Hawkins M, Lockwood G, Kim JJ, Cummings B, Knox J, et al. Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol 2008;26:657–64.
Chan LC, Chiu SKW, Chan SL. Stereotactic radiotherapy for hepatocellular carcinoma: report of a local single-centre experience. Hong Kong Med J Xianggang Yi Xue Za Zhi 2011; 17:112–8.
Dewas S, Mirabel X, Kramar A, Jarraya H, Lacornerie T, DewasVautravers C, et al. Stereotactic body radiation therapy for liver primary and metastases: the Lille experience. Cancer Radiother J Soc Francaise Radiother Oncol 2012;16:58–69.
Bae SH, Kim M-S, Cho CK, Kim KB, Lee DH, Han CJ, et al. Feasibility and efficacy of stereotactic ablative radiotherapy for Barcelona Clinic Liver Cancer-C stage hepatocellular carcinoma. J Korean Med Sci 2013;28:213–9.
Ohri N, Tomé WA, Méndez Romero A, Miften M, Ten Haken RK, Dawson LA, et al. Local Control After Stereotactic Body Radiation Therapy for Liver Tumors. Int J Radiat Oncol Biol Phys 2021;110:188–95.
Méndez Romero A, Wunderink W, Hussain SM, De Pooter JA, Heijmen BJM, Nowak PCJM, et al. Stereotactic body radiation therapy for primary and metastatic liver tumors: a single institution phase i-ii study. Acta Oncol Stockh Swed 2006;45: 831–7.
Louis C, Dewas S, Mirabel X, Lacornerie T, Adenis A, Bonodeau F, et al. Stereotactic radiotherapy of hepatocellular carcinoma: preliminary results. Technol Cancer Res Treat 2010;9:479–87.
Chantharasamee J, Chotiyaputta W, Nimmannit A, Techawatanawanna S. Survival outcomes of metastatic/ unresectable hepatocellular carcinoma in patients treated with sorafenib. J Med Assoc Thai 2019;102:107–12.
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