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

Abstract

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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“…Post-SBRT, improvement in abdominal pain and discomfort was experienced in 92% and 87% of patients respectively. Similarly, Choi et al 18 demonstrated that after palliative RT, pain improved in about 90% of HCC's patients.…”

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“…5 Choi et al has reported mOS of 13.3 months in pts with Hep B-related BCLC-C group of patients. 6 Evolving evidence has also suggested that concurrent use of immunotherapy with SBRT (SBRT-IO) has resulted in more powerful immune activation effects. In a study by Chiang et al, the overall response rate (ORR) was 87.5% (CR: 50%, PR: 37.5%) in the SBRT-IO arm as compared with 17% (CR: 2.4%, PR: 14.3%) in the TACE alone group.…”