Impact of fractionated stereotactic body radiotherapy on liver function in patients with hepatitis B virus-related hepatocellular carcinoma: Clinical and dosimetric analysis

Abstract

Objectives: To investigate the impact of fractionated stereotactic body radiotherapy (SBRT) on liver function and identify any dosimetric parameters that may predict deterioration of liver Junction in patients with hepatitis B (HBV)-related hepatocellular carcinoma (HCC). Methods: Thirty-six eligible patients with HBV-related HCC who were treated with fractionated SBRT between January 2008 and December 2010 were assessed. The treatment prescription ranged Jrom 20 to 40 Gy (median, 32 Gy) in 5 to 10 fractions over 1 to 2 weeks. All the patients received pre-emptive antiviral therapy. The median gross tumour volume was 509 cm3 (range, 2-3088 cm3). Four liver toxicity endpoints were assessed: (1) rate of HBV reactivation; (2) rate of chronic hepatitis B exacerbation; (3) rate of radiotherapy-induced liver disease; and (4) rate of deterioration in Child-Pugh class. Clinical and dosimetric parameters were evaluated to identify the significant predictors of liver toxicity. Results: No patient developed HBV reactivation, chronic hepatitis B exacerbation, or radiotherapy-induced liver disease within 3 months after SBRT. Four (11%) experienced Child-Pugh class deterioration. On univariate analysis, no clinical and dosimetric parameters were identified as predictors ojChild-Pugh class deterioration. Conclusion: SBRT with individualised dosing oj up to 40 Gy in 10 fractions can be delivered safely to patients with large unresectable HBV-related HCC in palliative setting. Pre-emptive antiviral therapy is probably mandatory to prevent HBV-related complications in this setting. © 2013 Hong Kong College of Radiologists.