Reply

Abstract

We appreciate the interests and comments by Sahai et al. The median dose of stereotactic body radiation therapy (SBRT) of our patients was 50 Gy (range 30–50 Gy).[1] In addition, the maximum dose of planning target volume was usually set at 130% of the prescribed dose, which ranged from 108% to 130% of the prescribed dose in our study. We are fully aware that a threshold of radiation dose for more than 700 or 800 cc of the uninvolved liver (i.e., liver minus gross tumor volume [GTV]) was set in other publications. It was not mandatory in our study, provided that the liver minus GTV mean dose, our priority criteria, was met. All patients had the same liver minus GTV dose constraints, regardless of their Child-Pugh status. Similarly, the Radiation Therapy Oncology Group (RTOG) 1112 protocol does not request that the radiation dose for more than 700 or 800 cc of the uninvolved liver must be met before SBRT is considered.[2] All of our patients treated with SBRT did not experience any serious adverse events or radiation-induced liver injury. We also thanked the readers for pointing out the minor differences in the eligibility criteria between the RTOG 1112 and our protocol. Although the eligibility criteria for SBRT in our study mostly followed the RTOG 1112 protocol, we loosened some eligibility criteria and accepted patients with platelet count of ≥ 20 × 109/L (≥ 70 × 109/L in RTOG protocol), serum albumin ≥ 25 g/L (≥28 g/L in RTOG protocol), and Child-Pugh score ≤ B8 (≤ A6 in RTOG protocol). Our previous experience revealed that these patients were safe to undergo SBRT. Finally, there was no specific dose constraint to skin in our study, as we considered it a minor concern. The maximum dose to the skin was 28.64 Gy. None developed skin toxicity after SBRT. Overall, we have shown that SBRT was safe with such slightly loosened criteria and that no patient developed grade ≥ 3 radiation–associated gastrointestinal and skin toxicity after SBRT.