Advertisement

Journal of Cancer Research and Clinical Oncology

, Volume 144, Issue 10, pp 2077–2083 | Cite as

Stereotactic body radiation therapy for centrally located hepatocellular carcinoma: outcomes and toxicities

  • Stanislav Lazarev
  • Camille Hardy-Abeloos
  • Oren Factor
  • Kenneth Rosenzweig
  • Michael Buckstein
Original Article – Clinical Oncology

Abstract

Purpose

To examine safety and efficacy of stereotactic body radiation therapy (SBRT) for centrally located hepatocellular carcinoma (CL-HCC).

Methods

Fifty-three patients with CL-HCC were treated with SBRT from 2011 to 2017 in our institution. CL-HCC was defined as a tumor sited in segments 4, 5, or 8 adjacent to the hepatic hilum, or < 1.5 cm from main portal branches. Primary endpoints were treatment response, local control (LC), and hepatobiliary toxicity (HBT).

Results

Thirty-three (62.3%) patients had Child–Turcotte–Pugh score A, 20 (37.77%)—score B. Albumin–bilirubin grade 1 constituted 6 (11.3%) cases, grade 2–32 (60.4%), grade 3–15 (28.3%). Median tumor diameter was 34 mm. Median BED10 was 72 Gy. Complete/partial response was observed in 40 (75.5%) lesions, stable disease—in 9 (17.0%). At a median follow-up of 12.2 months, there were 6 (11.3%) local failures. The actuarial 2-year LC rate was 87.9%. 2-year LC was better with higher BED10 (> 70 vs ≤ 70 Gy) 96.9 vs 72.5%, p = 0.01. The 2-year rates for disease-specific and overall survival were 53.2 and 39.1%, respectively. The incidence of any Grade ≥ 3 AE was 9 (17.0%). There were no grade 5 AEs. There was a trend toward an increased risk of grade ≥ 3 AE with mean liver dose > 10 Gy (p = 0.07).

Conclusions

In the present cohort, SBRT to the CL-HCC produced excellent treatment response with acceptable HBT and LC. Select HCC patients who are not candidates for surgery or other locoregional therapies can be considered for SBRT to the central liver.

Keywords

Hepatocellular carcinoma Central liver Stereotactic body radiation therapy Hepatobiliary toxicity Local control 

Notes

Funding

The authors received no specific funding for this work.

Compliance with ethical standards

Conflict of interest

The authors of the study have no commercial interests, and no actual, or potential conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

432_2018_2729_MOESM1_ESM.pdf (102 kb)
Supplementary material 1 (PDF 102 KB)

References

  1. Andolino DL, Johnson CS, Maluccio M et al (2011) Stereotactic body radiotherapy for primary hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 81:e447–e453CrossRefGoogle Scholar
  2. Bujold A, Massey CA, Kim JJ et al (2013) Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol 31:1631–1639CrossRefGoogle Scholar
  3. Cárdenes HR, Price TR, Perkins SM et al (2010) Phase I feasibility trial of stereotactic body radiation therapy for primary hepatocellular carcinoma. Clin Transl Oncol 12:218–225CrossRefGoogle Scholar
  4. Eriguchi T, Takeda A, Sanuki N et al (2013) Acceptable toxicity after stereotactic body radiation therapy for liver tumors adjacent to the central biliary system. Int J Radiat Oncol Biol Phys 85:1006–1011CrossRefGoogle Scholar
  5. Gkika E, Schultheiss M, Bettinger D et al (2017) Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma. Radiat Oncol 12:116CrossRefGoogle Scholar
  6. Huertas A, Baumann AS, Saunier-Kubs F et al (2015) Stereotactic body radiation therapy as an ablative treatment for inoperable hepatocellular carcinoma. Radiother Oncol 115:211–216CrossRefGoogle Scholar
  7. Jang WI, Kim MS, Bae SH et al (2013) High-dose stereotactic body radiotherapy correlates increased local control and overall survival in patients with inoperable hepatocellular carcinoma. Radiat Oncol 8:250CrossRefGoogle Scholar
  8. Kwon JH, Bae SH, Kim JY et al (2010) Long-term effect of stereotactic body radiation therapy for primary hepatocellular carcinoma ineligible for local ablation therapy or surgical resection. Stereotactic radiotherapy for liver cancer. BMC Cancer 10:475CrossRefGoogle Scholar
  9. Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60CrossRefGoogle Scholar
  10. Mendez Romero A, Wunderink W, Hussain SM et al (2006) Stereotactic body radiation therapy for primary and metastatic liver tumors: a single institution phase I-II study. Acta Oncol 45:831–837CrossRefGoogle Scholar
  11. Osmundson EC, Wu Y, Luxton G et al (2015) Predictors of toxicity associated with stereotactic body radiation therapy to the central hepatobiliary tract. Int J Radiat Oncol Biol Phys 91:986–994CrossRefGoogle Scholar
  12. Takeda A, Sanuki N, Tsurugai Y et al (2016) Phase 2 study of stereotactic body radiotherapy and optional transarterial chemoembolization for solitary hepatocellular carcinoma not amenable to resection and radiofrequency ablation. Cancer 122(13):2041–2049CrossRefGoogle Scholar
  13. Toesca DA, Osmundson EC, Eyben RV et al (2017) Central liver toxicity after SBRT: an expanded analysis and predictive nomogram. Radiother Oncol 122:130–136CrossRefGoogle Scholar
  14. Tse RV, Hawkins M, Lockwood G et al (2008) Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol 26:657–664CrossRefGoogle Scholar
  15. Wahl DR, Stenmark MH, Tao Y et al (2016) Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma. J Clin Oncol 34:452–459CrossRefGoogle Scholar
  16. Weiner AA, Olsen J, Ma D et al (2016) Stereotactic body radiotherapy for primary hepatic malignancies—report of a phase I/II institutional study. Radiother Oncol 121:79–85CrossRefGoogle Scholar
  17. Yamashita H, Onishi H, Murakami N et al (2015) Survival outcomes after stereotactic body radiotherapy for 79 Japanese patients with hepatocellular carcinoma. J Radiat Res 56:561–567CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Stanislav Lazarev
    • 1
  • Camille Hardy-Abeloos
    • 1
  • Oren Factor
    • 1
  • Kenneth Rosenzweig
    • 1
  • Michael Buckstein
    • 1
  1. 1.Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations