Clinical outcomes of stereotactic body radiation therapy for small hepatocellular carcinoma

Abstract

Background and Aim The purpose of this study was to investigate the long‐term oncologic outcomes after stereotactic body radiation therapy (SBRT) for small hepatocellular carcinoma (HCC). Methods A total of 290 patients with HCC were registered between March 2007 and July 2013. A dose of 10–15 Gy per fraction was given over three to four consecutive days, resulting in a total dose of 30–60 Gy. Overall and recurrence‐free survivals were estimated from the date of the start of SBRT to the date of death, the last follow‐up examination, or to the date of tumor recurrence. Results The median follow‐up period of all patients was 38.2 months, and the median tumor size was 1.7 cm. Overall survival (OS) rate at 5 years was 44.9%. Multivariate analyses revealed that age, Child–Pugh class, tumor size, and albumin levels were significant factors for OS. The 5‐year local control rate was 91.3%. In multivariate analysis, tumor size and albumin were significantly associated with local tumor control. However, there was a negative correlation between total dose and tumor size in Pearson's correlation analysis (r = −0.111, P = 0.046). Conclusions Stereotactic body radiation therapy was an excellent ablative treatment option for patients with small HCC. Tumor size was a significant factor for local tumor control after SBRT, although the total dose was negatively correlated with tumor size. Considering the low OS rates and the high local tumor control rates, the combined SBRT and systemic therapies may be beneficial for improving survival outcomes.

In reply to Huo et al.: Treating small hepatocellular carcinoma: Stereotactic body radiation therapy versus radiofrequency ablation

“…We thank Huo and colleagues 1 for the interest in our research on the clinical outcomes of stereotactic body radiation therapy (SBRT) for small hepatocellular carcinoma (HCC). 2 Huo and colleagues pointed out that the 5-year survival rate of our study (44.9%) is relatively low compared with that (65.1% in HCCs ≤3 cm) in a previous study on radiofrequency ablation (RFA) for HCC 3 and mentioned that our conclusions should be carefully interpreted.…”

“…However, it should be noted that a higher number of prior treatment sessions was associated with worse prognosis in patients with HCC. 2,5 In previous studies, the proportion of treatment-naïve patients was usually higher in patients receiving RFA than those receiving SBRT. Whereas Shiina et al reported the long-term outcomes of RFA as an initial treatment for HCC in all of the enrolled patients, 3 only eight (2.8%) patients in our study were treated with SBRT as an initial treatment for HCC.…”

“…As we mentioned in our paper, none of the enrolled patients were feasible for RFA because of the above-mentioned clinical situations. 2 As such, our study was not particularly focused on comparing SBRT and RFA for small HCC, but rather on assessing the long-term oncologic outcomes of SBRT as a treatment option in patients with small HCCs that are not amenable to curative treatments including RFA.…”

“…Whereas Shiina et al reported the long-term outcomes of RFA as an initial treatment for HCC in all of the enrolled patients, 3 only eight (2.8%) patients in our study were treated with SBRT as an initial treatment for HCC. 2 SBRT was not considered as one of the curative treatment options because most patients who received SBRT as an alternative treatment had received various locoregional therapies for previously diagnosed HCCs, and therefore, the expected overall survival rates after SBRT might be lower than those after RFA. 2 The baseline liver function is also an important clinical parameter for overall survival in patients with HCC.…”

Treating Small Hepatocellular Carcinoma: Stereotactic Body Radiation Therapy Versus Radiofrequency Ablation

“…We read with interest the paper "Clinical outcomes of stereotactic body radiation therapy for small hepatocellular carcinoma" published in an upcoming issue of Journal of Gastroenterology and Hepatology. 1 It is an elegant study that investigated the long-term outcomes of patients with hepatocellular carcinoma (HCC) undergoing stereotactic body radiation therapy (SBRT). Although the findings highlight the potential role of SRBT in treating small HCC, the conclusions remain to be carefully interpreted.…”