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Journal of Cancer Research and Clinical Oncology

, Volume 141, Issue 7, pp 1301–1309 | Cite as

The challenge of inoperable hepatocellular carcinoma (HCC): results of a single-institutional experience on stereotactic body radiation therapy (SBRT)

  • Marta Scorsetti
  • Tiziana Comito
  • Luca Cozzi
  • Elena Clerici
  • Angelo Tozzi
  • Ciro Franzese
  • Pierina Navarria
  • Antonella Fogliata
  • Stefano Tomatis
  • Giuseppo D’Agostino
  • Cristina Iftode
  • Pietro Mancosu
  • Roberto Ceriani
  • Guido Torzilli
Original Article – Clinical Oncology

Abstract

Objectives

To evaluate the feasibility and efficacy of stereotactic body radiation therapy (SBRT) in the treatment of hepatocellular carcinoma (HCC) unsuitable for standard loco-regional therapies.

Materials and methods

Patients with 1–3 inoperable HCC lesions with diameter ≤6 cm were treated by SBRT. According to lesions size and liver function, two prescription regimens were adopted: 48–75 Gy in three fractions or 36–60 Gy in six fractions. SBRT was delivered using the volumetric modulated arc therapy technique with flattening filter-free photon beams. The primary end points of this study were in-field local control (LC) and toxicity. Secondary end points were overall survival (OS) and progression-free survival (PFS).

Results

Forty-three patients with 63 HCC lesions were irradiated. All patients had Child–Turcotte–Pugh class A or B disease. Thirty lesions (48 %) were treated with 48–75 Gy in three consecutive fractions, and 33 (52 %) received 36–60 Gy in six fractions. Median follow-up was 8 months (range 3–43 months). Actuarial LC at 6, 12 and 24 months was 94.2 ± 3.3, 85.8 ± 5.5 and 64.4 ± 11.5 %, respectively. A biological equivalent dose (BED) >100 Gy and GTV size were significant prognostic factors for LC in univariate analysis (p < 0.001 and p < 0.02). Median OS was 18.0 ± 5.8 months. Actuarial OS at 6, 12 and 24 months was 91.1 ± 4.9, 77.9 ± 8.2 and 45.3 ± 14.0 %, respectively. Univariate analysis showed that OS is correlated with LC (p < 0.04), BED >100 (p < 0.05) and cumulative gross tumor volume GTV <5 cm (p < 0.04). Median PFS was 8 months, with a 1-year PFS rate of 41 %. A significant (≥grade 3) toxicity was observed in seven patients (16 %) 2–6 months after the completion of the treatment. No classic radiation-induced liver disease was observed.

Conclusion

Stereotactic body radiation therapy is a safe and effective therapeutic option for HCC lesions unsuitable to standard loco-regional therapies, with acceptable local control rates and low treatment-related toxicity. The significant correlation between LC and higher doses and between LC and OS supports the clinical value of SBRT in these patients.

Keywords

Liver Hepatocellular carcinoma RapidArc Stereotactic body radiation therapy 

Notes

Conflict of interest

L. Cozzi acts as Scientific Advisor to Varian Medical Systems and is Clinical Research Scientist at Humanitas cancer center. All other co-authors have no conflicts of interests.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Marta Scorsetti
    • 1
  • Tiziana Comito
    • 1
  • Luca Cozzi
    • 1
    • 3
  • Elena Clerici
    • 1
  • Angelo Tozzi
    • 1
  • Ciro Franzese
    • 1
  • Pierina Navarria
    • 1
  • Antonella Fogliata
    • 2
  • Stefano Tomatis
    • 1
  • Giuseppo D’Agostino
    • 1
  • Cristina Iftode
    • 1
  • Pietro Mancosu
    • 1
  • Roberto Ceriani
    • 1
  • Guido Torzilli
    • 1
  1. 1.Radiotherapy and Radiosurgery, Oncology, Liver Surgery, Hepatology DepartmentsHumanitas Clinical and Research CenterRozzanoItaly
  2. 2.Medical Physics UnitOncology Institute of Southern SwitzerlandBellinzonaSwitzerland
  3. 3.Humanitas Research HospitalIstituto Clinico HumanitasRozzanoItaly

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