Impact of Fractionated Stereotactic Body Radiotherapy on Liver Function in Patients with Hepatitis B Virus–related Hepatocellular Carcinoma: Clinical and Dosimetric Analysis

Abstract

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.

Long-term Results of Palliative Stereotactic Radiotherapy of Barcelona Clinic Liver Cancer Stage C Hepatitis B–Related Hepatocellular Carcinoma

“…In terms of efficacy, we previously demonstrated the response to and efficacy of moderate doses of hypofractionated SBRT for patients with unresectable HCC. 7 Most patients had significant pain relief after radiotherapy. In the present study, we investigated the long-term efficacy of palliative SBRT for HBV-related HCC.…”

“…Eligibility criteria are described in our previous paper studying the impact of SBRT on liver function, with stages other than BCLC stage C excluded. 7…”

“…Patients were prescribed 4 Gy per fraction to the planning target volume for five to 10 fractions. 7…”

“…3 With the advances in radiotherapy planning and delivery, 4 SBRT has been shown to be a safe and effective treatment for unresectable HCC. [5][6][7] The National Comprehensive Cancer Network Guidelines for HCC recommends RT as a locoregional therapy option. 8 To the best of our knowledge, there is limited literature evaluating the role of SBRT in BCLC stage C HBVrelated HCC.…”

“…8 To the best of our knowledge, there is limited literature evaluating the role of SBRT in BCLC stage C HBVrelated HCC. In our previous paper, 7 we reported radiotherapy details, short-term response, safety, and toxicity of palliative SBRT in 36 patients with HBVrelated HCC. In the present study, we investigated the long-term efficacy of palliative SBRT for HBV-related HCC, as well as prognostic factors.…”