Consensus on Stereotactic Body Radiation Therapy for Small-Sized Hepatocellular Carcinoma at the 7th Asia-Pacific Primary Liver Cancer Expert Meeting

Abstract

Background: Stereotactic body radiation therapy (SBRT) is an advanced technique of external beam radiation therapy that delivers large ablative doses of radiation. In the past decade, many cancer centers have adopted SBRT as one mode of radically treating small-sized hepatocellular carcinoma (HCC), based on encouraging clinical outcomes. SBRT thus seems reasonable as first-line treatment of inoperable HCC confined to the liver. However, most of the clinical studies to date have been retrospective in nature, with key issues still under investigation. Summary: The above-mentioned publications were subjected to scrutiny, fueling discussions at the 7th Asia-Pacific Primary Liver Cancer Expert (APPLE 2016) Meeting on various clinical variables, such as indications for SBRT, therapeutic outcomes, treatment-related toxicities, doses prescribed, and specific techniques. The consensus reached should be of interest to all professionals active in the treatment of HCC, especially radiation oncologists. Key Messages: SBRT is a safe and effective therapeutic option for patients with small-sized HCC, offering substantial local control, improved overall survival, and low toxicity.

Stereotactic body radiation therapy for hepatocellular carcinoma: Practice patterns, dose selection and factors impacting survival

“…This study confirms the wide variation of regimens used in clinical practice and identifies 50 Gy in five fractions as the most common scheme in this cohort of patients treated in the United States, which is also the recommended dose on the currently enrolling RTOG 1112 protocol, if liver constraints can be achieved. The variation in treatment regimens reflects the multiple factors that are considered in determining the dose including the size and location of the lesion, the radiation tolerance of nearby organs, liver health, the amount of liver spared from significant radiation doses, institutional preference, and organ motion managment …”

Challenges of BCLC stage C hepatocellular carcinoma

“…Previous prospective and retrospective studies have shown excellent results of SBRT on small and early stage HCC, [ 14 ] however, until now there was limited data of the use of SBRT on BCLC stage C HCC. As BCLC-C is a heterogenous population with various adverse features and a dismal prognosis, delivering high doses to this group of patients is often challenging as higher mean radiation doses to the liver might compromise the liver function and increase the risk for liver failure.…”

Hong Kong Consensus Statements for the Management of Unresectable Hepatocellular Carcinoma

“…While some studies have suggested avoiding SBRT in patients with Child-Pugh score of B8 and above except as a bridge to transplant [63,64], other studies of SBRT have included small numbers of such patients with encouraging results [65,66]. A recent consensus statement recommends that SBRT be used with caution in all ChildPugh B patients and only at low-dose volumes [67]. Clinical practice in Hong Kong is to treat selected Child-Pugh B8 patients with SBRT at the discretion of the treating physicians.…”