Stereotactic body radiation therapy for hepatocellular carcinoma: Review of a local hospital

Abstract

© 2017 Hong Kong College of Radiologists. Objective: To review the outcome and safety of stereotactic body radiation therapy (SBRT) for patients with hepatocellular carcinoma (HCC). Methods: Patients who underwent SBRT for HCC between January 2013 and March 2016 at Queen Elizabeth Hospital were reviewed retrospectively. Tumour response and toxicities were evaluated. Local control and overall survival rates were calculated using the Kaplan-Meier method. Results: 31 male and 8 female patients aged 54 to 90 (median, 72) years were included. 35 patients had Child- Pugh class A cirrhosis. 35 patients had viral hepatitis, of whom 33 were hepatitis B carriers. One patient was treatment native and underwent SBRT as bridging therapy prior to liver transplantation. The remaining 38 patients had received prior loco-regional therapies. The median tumour size was 1.9 cm. 29 patients had only one lesion. The SBRT doses ranged from 30 to 54 Gy in 6 to 7 fractions. After a median follow-up period of 17.8 months, 13 patients had died. The 1- and 2-year overall survival rates were 73.6% and 56.1%, respectively, and the median overall survival was 30.1 months. In 38 patients followed up at 3 months, 28.9%, 23.7%, and 42.1% had a complete response, partial response, and stable disease, respectively. The actuarial local control rate at 1 year was 82.8%. 21 patients had intrahepatic out-of-field recurrence, and four patients had distant metastasis. The 1-year intrahepatic recurrence-free survival was 50.5%, and the median intrahepatic recurrence-free survival was 15.4 months. 13 patients had grade 3 or above toxicity, of whom eight had thrombocytopaenia. One patient had grade 3 hepatic and renal toxicities and died after 2 months due to liver failure and hepatorenal syndrome. Conclusion: SBRT is effective and safe even in previously treated patients. It results in good local control with minimal severe adverse events but a relatively high intrahepatic (out-of-field) recurrence rate.