Stereotactic body radiation therapy for primary liver tumors with adverse factors

Abstract

Aim: To test the efficacy and safety of liver stereotactic body radiation therapy (SBRT) in patients who harbor adverse factors.

Methods: We retrospectively evaluated the outcomes of liver SBRT in a single cancer center. We invented criteria consisting of two physical factors and two tumor factors to measure the treatment difficulty in each case. The clinical outcomes and toxicity were evaluated by stratification of the harboring factors.

Results: A total of 24 (23 hepatocellular carcinoma and 1 intrahepatic cholangiocarcinoma) patients were eligible for this study, with a median follow-up duration of 18 months. Of all eligible patients, 21 patients (88%) had one or more factors. The local control, progression-free survival, and overall survival rates for all patients at 2 years were 89%, 42%, and 76% respectively. In the patients with physical and tumor adverse factors, local control/progression-free survival/overall survival rates at 2 years were 100%/42%/69% and 80%/23%/78%, respectively. The subgroup of 11 patients with 2 or more factors showed comparable local control rate at 2 years to the subgroup of 13 patients with 0 to 1 factors (100% vs. 86%, P = 0.59). One patient (4.2%) experienced a decline in the Child-Pugh score by 2 points at 3 months after the treatment. Grade 2 to 3 gastrointestinal toxicity was observed in three patients.

Conclusion: SBRT showed a high local control rate with acceptable toxicity for the group of liver cancer patients harboring both physical and tumor adverse factors as long as conducted following patient selection and dose constraints that were used in this study.

Keywords

Hepatocellular carcinoma / stereotactic body radiation therapy / vulnerable patients

References

[1] Akinyemiju T,Ahmed M.Global burden of disease liver cancer collaboration. the burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: results from the global burden of disease study 2015..JAMA Oncol2017;3:1683-91 PMCID:PMC5824275

[2] Hori M,Shibata A,Sobue T.Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project..Jpn J Clin Oncol2015;45:884-91

[3] Omata M,Kokudo N,Lee JM.Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update..Hepatol Int2017;11:317-70 PMCID:PMC5491694

[4] Heimbach JK,Finn RS,Abecassis MM.AASLD guidelines for the treatment of hepatocellular carcinoma..Hepatology2018;67:358-80

[5] Murray LJ.Advances in stereotactic body radiation therapy for hepatocellular carcinoma..Semin Radiat Oncol2017;27:247-55

[6] Bujold A,Kim JJ,Cho C.Sequential phase I and II trial stereotactic body radiotherapy for locally advanced hepatocellular carcinoma..J Clin Oncol2013;31:1631-9

[7] Kang JK,Cho CK,Yoo HJ.Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete transarterial chemoembolization..Cancer2012;118:5424-31

[8] Durand-Labrunie J,Ayav A,Boleslawski E.Curative irradiation treatment of hepatocellular carcinoma: a multicenter phase 2 trial..Int J Radiat Oncol Biol Phys2020;107:116-25

[9] Charlson ME,Ales KL,Tang GJ.A new method of classifying prognostic comorbidity in longitudinal studies: development and validation..J Chronic Dis1987;40:373-83

[10] Michel R,Laure P,Guillaume P.Dose to organ at risk and dose prescription in liver SBRT..Rep Pract Oncol Radiother2017;22:96-102 PMCID:PMC5411900

[11] Ohri N,Méndez Romero A,Ten Haken RK.Local control after stereotactic body radiation therapy for liver tumors..Int J Radiat Oncol Biol Phys2018;doi: 10.1016/j.ijrobp.2017.12.288 PMCID:PMC6102100

[12] Sanuki N,Oku Y,Aoki Y.Stereotactic body radiotherapy for small hepatocellular carcinoma: a retrospective outcome analysis in 185 patients..Acta Oncol2014;53:399-04

[13] Culleton S,Haddad CR,Brierley J.Outcomes following definitive stereotactic body radiotherapy for patients with Child-Pugh B or C hepatocellular carcinoma..Radiother Oncol2014;111:412-7

[14] Rosenberg SA,Shaverdian N,Wojcieszynski AP.A multi-institutional experience of MR-guided liver stereotactic body radiation therapy..Adv Radiat Oncol2018;4:142-9 PMCID:PMC6349638

[15] Hong TS,Yeap BY,McDonnell EI.Multi-institutional phase ii study of high-dose hypofractionated proton beam therapy in patients with localized, unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma..J Clin Oncol2016;34:460-8 PMCID:PMC4872014

[16] Cheung TT,Yuen WK,Jenkins CR.Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience..Ann Surg2013;257:506-11

[17] Yoon YI,Kang SH,Shin MH.Pure laparoscopic versus open right hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score matched analysis..Ann Surg2017;265:856-63

[18] Liu R,Kim HJ,Yiengpruksawan A.International consensus statement on robotic hepatectomy surgery in 2018..World J Gastroenterol2019;25:1432-44 PMCID:PMC6441912