Bullet fragment fiducials in stereotactic body radiotherapy as a bridge to transplant for hepatocellular carcinoma

167 Background: Assessment of outcomes in patients with hepatocellular carcinoma (HCC) and Child-Pugh B or C liver function treated with stereotactic body radiotherapy (SBRT). Methods: From 2004 – July 2012, 39 patients with HCC and Child-Pugh B/C liver function were treated with SBRT. Inclusion criteria included Child-Pugh B/C, treatment with SBRT, 5 to 15 fractions, and radical or palliative intent. Univariate analyses (UVA) were performed to assess relationships of patient demographics, liver function tests and treatment characteristics on overall survival (OS) and time to progression (TTP). Results: The majority of the 39 patients had Child-Pugh B7 liver function (69%), performance status ECOG 0-1 (82%), radiological evidence of tumor vascular thrombosis (62%) and hepatitis C as underlying liver disease (49%). 10 patients treated as bridge-to-transplant. The median dose was 3300 cGy in 6 fractions (range: 2000-4500 cGy in 5-15 fractions), individualized based on spared liver volume and underlying liver function. The median survival for all patients was 9.9 months (95% CI: 3.4-18.4). UVA demonstrated significantly reduced survival with Child-Pugh score > B7, baseline AFP > 1049 ng/mL (upper quartile) and gross tumor volume > 93 cm3. The median survival of patients treated with SBRT as a bridge-to-transplant versus the non-bridge-to–transplant patients was 30.7 months (95% CI: 0.6-not reached) versus 7.9 months (95% CI: 3.4-15.1; p=0.008). No HCC tumors treated with SBRT demonstrated local progression during the follow-up time. The median TTP for all patients was 18.8 months (95% CI: 6.2-not reached). Model for end stage liver disease (MELD) score > 12 was the only factor associated with reduced TTP on UVA. 31% of patients had a decline in Child-Pugh score by 2 or more points at 3 months. No acute treatment related toxicities of grade 3 or higher were reported. Conclusions: SBRT may be considered as a treatment option for HCC with impaired liver function. Survival is best in patients who are treated as a bridge-to-transplant, have smaller tumors, are Child-Pugh class B7, and have lower AFP levels. Randomized trials of radiation therapy in HCC patients with impaired liver function are warranted.

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Faculty Opinions recommendation of Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725979903.793512329 ◽

2015 ◽

Author(s):

Eugene Koay

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Stereotactic Body Radiotherapy

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Clinical outcomes of stereotactic body radiotherapy for elderly patients with hepatocellular carcinoma

Hepatology Research ◽

10.1111/hepr.12916 ◽

2017 ◽

Vol 48 (2) ◽

pp. 193-204 ◽

Cited By ~ 5

Author(s):

Yuji Teraoka ◽

Tomoki Kimura ◽

Hiroshi Aikata ◽

Kana Daijo ◽

Mitsutaka Osawa ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Elderly Patients ◽

Clinical Outcomes ◽

Stereotactic Body Radiotherapy

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Stereotactic Body Radiotherapy for Patients With Unresectable Primary Hepatocellular Carcinoma: Dose-Volumetric Parameters Predicting the Hepatic Complication

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2009.09.009 ◽

2010 ◽

Vol 78 (4) ◽

pp. 1073-1080 ◽

Cited By ~ 92

Author(s):

Seok Hyun Son ◽

Byung Ock Choi ◽

Mi Ryeong Ryu ◽

Young Nam Kang ◽

Ji Sun Jang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Stereotactic Body Radiotherapy ◽

Primary Hepatocellular Carcinoma

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Bi/Se-Based Nanotherapeutics Sensitize CT Image-Guided Stereotactic Body Radiotherapy through Reprogramming the Microenvironment of Hepatocellular Carcinoma

ACS Applied Materials & Interfaces ◽

10.1021/acsami.1c11763 ◽

2021 ◽

Author(s):

Jiani Liu ◽

Jiayao Chen ◽

Hongxing Liu ◽

Ke Zhang ◽

Qi Zeng ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Stereotactic Body Radiotherapy ◽

Ct Image ◽

Image Guided

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Multicenter Prospective Study of Stereotactic Body Radiotherapy for Untreated Solitary Primary Hepatocellular Carcinoma: The STRSPH Study

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2019.06.1978 ◽

2019 ◽

Vol 105 (1) ◽

pp. E223 ◽

Cited By ~ 1

Author(s):

T. Kimura ◽

A. Takeda ◽

S. Ishikura ◽

K. Ariyoshi ◽

T. Yamaguchi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prospective Study ◽

Stereotactic Body Radiotherapy ◽

Primary Hepatocellular Carcinoma ◽

Multicenter Prospective Study

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Combination Therapy after TACE for Hepatocellular Carcinoma with Macroscopic Vascular Invasion: Stereotactic Body Radiotherapy versus Sorafenib

Cancers ◽

10.3390/cancers10120516 ◽

2018 ◽

Vol 10 (12) ◽

pp. 516 ◽

Cited By ~ 2

Author(s):

Lujun Shen ◽

Mian Xi ◽

Lei Zhao ◽

Xuhui Zhang ◽

Xiuchen Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Stereotactic Body Radiotherapy ◽

Vascular Invasion ◽

Progression Free Survival ◽

Sorafenib Treatment ◽

Free Survival ◽

Sorafenib Group ◽

Treatment Responses ◽

Hepatic Lesions ◽

Macroscopic Vascular Invasion

Stereotactic body radiotherapy (SBRT) has shown promising results in the control of macroscopic vascular invasion in patients with hepatocellular carcinoma (HCC); however, its efficacy in comparison to sorafenib when combined with transarterial chemoembolization (TACE) remains to be determined. Between 2009 and 2017, 77 HCC patients with macroscopic vascular invasion receiving TACE–SBRT or TACE–sorafenib combination therapies were enrolled. The best treatment responses, overall survival (OS), and progression-free survival (PFS) of the two treatment arms were compared. Of the patients enrolled, 26 patients (33.8%) received TACE–SBRT treatment, and 51 (66.2%) received TACE–sorafenib treatment. The patients in the TACE–SBRT group were more frequently classified as elder in age (p = 0.012), having recurrent disease (p = 0.026), and showing lower rates of multiple hepatic lesions (p = 0.005) than patients in TACE–sorafenib group. After propensity score matching (PSM), 26 pairs of well-matched HCC patients were selected; patients in the TACE–SBRT group showed better overall response rates in trend compared to those in the TACE–sorafenib group. The hazard ratio (HR) of OS to PFS for the TACE–SBRT approach and the TACE–sorafenib approach was 0.36 (95% CI, 0.17–0.75; p = 0.007) and 0.35 (95% CI, 0.20–0.62; p < 0.001), respectively. For HCC patients with macrovascular invasion, TACE plus SBRT could provide improved OS and PFS compared to TACE–sorafenib therapy.

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