Skip to main content
SpringerLink
Log in

Liver stereotactic radiotherapy (SRT) with functional treatment planning for patients with intermediate stage hepatocellular carcinoma (HCC)

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

The objective of this study was to analyze hepatic failure progression and survival in patients with Barcelona Clinic Liver Cancer (BCLC) A3-B hepatocellular carcinoma (HCC) after stereotactic radiotherapy (SRT) with functional treatment planning.

Methods

Liver SPECT was co-registered to 4DCT for avoidance of functional liver during SRT planning. Liver dose constraints/fractionation was based on functional liver volume. Concurrent capecitabine was administered for fraction size ≤ 4 Gy. Hepatic function, toxicity, and radiographic response were documented q4–6 months following radiotherapy.

Results

Twenty-two patients (14 Child-Pugh A, 8 Child-Pugh B Cirrhosis) with 39 lesions were analyzed. Fourteen patients received SBRT (mean dose 44.7 Gy, 5–6 fractions). Eight patients received SRT and concurrent capecitabine (mean dose 40.7 Gy, 14–18 fractions). Mean follow-up was 20 months. Nine patients developed grade ≤ 2 transient elevation of liver enzymes. At 24 months, Child-Pugh class was stable in 59% patients and MELD progression free survival was 76%. No RILD or accelerated hepatic failure was observed. In-field local control was 97.4% and overall survival was 59% at 2 years.

Conclusions

Liver SRT with functional treatment planning is safe in intermediate hepatocellular carcinoma. Liver failure is not hastened despite the inclusion of 36% Child-Pugh B patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. American Cancer Society (2016) Cancer facts and figures 2016. American Cancer Society, Atlanta http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079. Accessed 24 Jan 2016

    Google Scholar 

  2. “Liver Cancer Home Page.” National Cancer Institute. N.p., n.d. Web. 24 July 2014. https://www.cancer.gov/types/liver/hp/adult-liver-treatment-pdq

  3. Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP (2006) The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 45(4):529–538

    Article  PubMed  Google Scholar 

  4. O’leary JG, Landaverde C, Jennings L, Goldstein RM, Davis GL (2011) Patients with NASH and cryptogenic cirrhosis are less likely than those with hepatitis C to receive liver transplants. Clin Gastroenterol Hepatol 9(8):700–704.e1

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ascha MS, Hanouneh IA, Lopez R, Tamimi TA, Feldstein AF, Zein NN (2010) The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology 51(6):1972–1978

    Article  PubMed  Google Scholar 

  6. Choi E, Rogers E, Ahmad S, Abdalla EK (2006) Hepatobiliary cancers. In: Feig BW, Berger DH, Fuhrman GM (eds) The M. D. Anderson surgical oncology handbook. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  7. Teh SH, Christein J, Donohue J, Que F, Kendrick M, Farnell M et al (2005) Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: Model of End-Stage Liver Disease (MELD) score predicts perioperative mortality. J Gastrointest Surg 9(9):1207–1215

    Article  PubMed  Google Scholar 

  8. Cucchetti A, Ercolani G, Vivarelli M, Cescon M, Ravaioli M, La Barba G et al (2006) Impact of Model for End-Stage Liver Disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl 12(6):966–971

    Article  PubMed  Google Scholar 

  9. Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS (1999) Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 210(3):655–661

    Article  CAS  PubMed  Google Scholar 

  10. Thornton RH, Covey A, Petre EN, Riedel ER, Maluccio MA, Sofocleous CT et al (2009) A comparison of outcomes from treating hepatocellular carcinoma by hepatic artery embolization in patients younger or older than 70 years. Cancer 115(21):5000–5006

    Article  PubMed  Google Scholar 

  11. Mendez-Romero A, Wunderink W, Hussain SM, De Pooter JA, Heijmen BJ, Nowak PC et al (2006) Stereotactic body radiation therapy for primary and metastatic liver tumors: A single institution phase i-ii study. Acta Oncol 45:831–837

    Article  PubMed  Google Scholar 

  12. Cardenes HR, Price TR, Perkins SM, Maluccio M, Kwo P, Breen TE et al (2010) Phase I feasibility trial of stereotactic body radiation therapy for primary hepatocellular carcinoma. Clin Transl Oncol 12:218–225

    Article  CAS  PubMed  Google Scholar 

  13. Andolino DL, Johnson CS, Maluccio M, Kwo P, Tector AJ, Zook J et al (2011) Stereotactic body radiotherapy for primary hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 81(4):e447–e453

    Article  PubMed  Google Scholar 

  14. Dawson LA (2011) Overview: where does radiation therapy fit in the spectrum of liver cancer local-regional therapies? Semin Radiat Oncol 21(4):241–246

    Article  PubMed  Google Scholar 

  15. Xu ZY, Liang SX, Zhu J, Zhu XD, Zhao JD, Lu HJ et al (2006) Prediction of radiation-induced liver disease by Lyman normal-tissue complication probability model in three-dimensional conformal radiation therapy for primary liver carcinoma. Int J Radiat Oncol Biol Phys 65(1):189–195

    Article  PubMed  Google Scholar 

  16. Gayou O, Day E, Mohammadi S, Kirichenko A (2012) A method for registration of single photon emission computed tomography (SPECT) and computed tomography (CT) images for liver stereotactic radiotherapy (SRT). Med Phys 39(12):7398–7401

    Article  PubMed  Google Scholar 

  17. Kirichenko A, Gayou O, Parda D, Kudithipudi V, Tom K, Khan A et al (2016) Stereotactic body radiotherapy (SBRT) with or without surgery for primary and metastatic liver tumors. HPB (Oxford) 18(1):88–97

    Article  Google Scholar 

  18. Kamath PS, Kim WR (2007) The Model for End-Stage Liver Disease (MELD). Hepatology 45(3):797–805

    Article  PubMed  Google Scholar 

  19. Bujold A, Massey CA, Kim JJ, Brierley J, Cho C, Wong RK et al (2013) Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol 31(13):1631–1639

    Article  PubMed  Google Scholar 

  20. Mcintosh A, Hagspiel KD, Al-osaimi AM, Northup P, Caldwell S, Berg C et al (2009) Accelerated treatment using intensity-modulated radiation therapy plus concurrent capecitabine for unresectable hepatocellular carcinoma. Cancer 115(21):5117–5125

    Article  CAS  PubMed  Google Scholar 

  21. Ozaki K, Matsui O, Kobayashi S, Minami T, Kitao A, Gabata T (2016) Morphometric changes in liver cirrhosis: aetiological differences correlated with progression. Br J Radiol 89(1059):20150896

    Article  PubMed  PubMed Central  Google Scholar 

  22. Parikh ND, Waljee AK, Singal AG (2015) Downstaging hepatocellular carcinoma: a systematic review and pooled analysis. Liver Transpl 21(9):1142–1152

    Article  PubMed  Google Scholar 

  23. Fleming KM, Aithal GP, Card TR, West J (2012) All-cause mortality in people with cirrhosis compared with the general population: a population-based cohort study. Liver Int 32(1):79–84

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Radiation Oncology, Allegheny General Hospital, 320 East North Avenue, Floor 02, Pittsburgh, PA, 15212, USA

    Vijay Kudithipudi, Ellen Day & Alexander Kirichenko

  2. Division of Transplant Surgery, Allegheny General Hospital, Pittsburgh, PA, USA

    Ngoc Thai

Authors
  1. Vijay Kudithipudi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ellen Day
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ngoc Thai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander Kirichenko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vijay Kudithipudi.

Ethics declarations

Funding

The work was supported by the Division of Radiation Oncology within the Allegheny Health Network Cancer Center in Pittsburgh, PA.

Conflict of interest

The authors declare that they have no conflict 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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kudithipudi, V., Day, E., Thai, N. et al. Liver stereotactic radiotherapy (SRT) with functional treatment planning for patients with intermediate stage hepatocellular carcinoma (HCC). J Radiat Oncol 6, 371–377 (2017). https://doi.org/10.1007/s13566-017-0325-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13566-017-0325-4

Keywords

Search

Navigation