Objectives: To investigate the impact of fractionated stereotactic body radiotherapy (SBRT) on liver function and identify any dosimetric parameters that may predict deterioration of liver function in patients with hepatitis B (HBV)-related hepatocellular carcinoma (HCC). Methods: Thirty-six eligible patients with HBV-related HCC who were treated with fractionated SBRT between January 2008 and December 2010 were assessed. The treatment prescription ranged from 20 to 40 Gy (median, 32 Gy) in 5 to 10 fractions over 1 to 2 weeks. All the patients received pre-emptive antiviral therapy. The median gross tumour volume was 509 cm 3 (range, 2-3088 cm 3). Four liver toxicity endpoints were assessed: (1) rate of HBV reactivation; (2) rate of chronic hepatitis B exacerbation; (3) rate of radiotherapy-induced liver disease; and (4) rate of deterioration in Child-Pugh class. Clinical and dosimetric parameters were evaluated to identify the significant predictors of liver toxicity. Results: No patient developed HBV reactivation, chronic hepatitis B exacerbation, or radiotherapy-induced liver disease within 3 months after SBRT. Four (11%) experienced Child-Pugh class deterioration. On univariate analysis, no clinical and dosimetric parameters were identified as predictors of Child-Pugh class deterioration. Conclusion: SBRT with individualised dosing of up to 40 Gy in 10 fractions can be delivered safely to patients with large unresectable HBV-related HCC in palliative setting. Pre-emptive antiviral therapy is probably mandatory to prevent HBV-related complications in this setting.

Objective: To assess the long-term effectiveness of palliative stereotactic body radiotherapy (SBRT) in patients with large unresectable Barcelona Clinic Liver Cancer stage C hepatitis B-related hepatocellular carcinomas (HCCs). Methods: Consecutive HCC cases treated with fractionated SBRT between January 2008 and December 2010 were analysed. The long-term survival and response rate were evaluated. Univariate and multivariate analyses were performed to identify the significant predictors of survival. Results: In total, 32 cases were analysed, with median gross tumour volume was 509.5 cm 3 (range, 2.2-3088 cm 3 ). Median treatment prescription was 32 Gy (range, in five to 10 fractions over 1 to 2 weeks. Median followup was 13.4 months; median survival was 13.3 months (95% confidence interval [CI]=11.4-15.2). Stable and partial tumour response rates by RECIST criteria were 69% and 31%, respectively. Alpha-fetoprotein reduction at ≥3 months after radiotherapy (p = 0.018) and gain in body weight after SBRT (p < 0.001) were significantly associated with longer survival after multivariate analysis. Conclusion: SBRT with dose individualisation can be delivered safely to large unresectable tumours in patients withHBV-related HCC. The median survival after SBRT in this study was 13.3 months. Alpha-fetoprotein reduction at ≥3 months and weight gain after radiotherapy were positive prognostic factors for longer survival. More prospective studies are warranted to confirm these results.

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Introduction: This study aims to determine the outcomes of stereotactic body radiotherapy (SBRT) for liver metastases in patients not eligible for surgery.Methods: This study included 31 consecutive patients with unresectable liver metastases who received SBRT between January 2012 and December 2017; 22 patients had primary colorectal cancer and nine patients had primary non-colorectal cancer. Treatments ranged from 24 Gy to 48 Gy in 3 to 6 fractions over 1 to 2 weeks. Survival, response rates, toxicities, clinical characteristics, and dosimetric parameters were evaluated. Multivariate analysis was performed to identify significant prognostic factors for survival.Results: Among these 31 patients, 65% had received at least one prior regimen of systemic therapy for metastatic disease, whereas 29% had received chemotherapy for disease progression or immediately after SBRT. The median follow-up interval was 18.9 months; actuarial in-field local control rates at 1, 2, and 3 years after SBRT were 94%, 55%, and 42%, respectively. The median survival duration was 32.9 months; 1-year, 2-year, and 3-year actuarial survival rates were 89.6%, 57.1%, and 46.2%, respectively. The median time to progression