Stereotactic body radiotherapy combined with transarterial chemoembolization for huge (≥10 cm) hepatocellular carcinomas: A clinical study

Abstract

Abstract. This study was conducted to evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) combined with transarterial chemoembolization (TACE) for huge (≥10 cm) hepatocellular carcinomas (HCCs). Between May, 2006 and December, 2012, 72 patients with huge HCCs were treated by SBRT following incomplete TACE. The median total dose of 35.6 Gy was delivered over 12-14 days with a fractional dose of 2.6-3.0 Gy and 6 fractions per week. The patients were classified into those with tumor encapsulation (group A, n=33) and those without tumor encapsulation (group B, n=39). The clinical outcomes of tumor response, overall cumulative survival and toxicities/complications were retrospectively analyzed. Among the 72 patients, CR, PR, SD and PD were achieved in 6 (8.3%), 51 (70.8%), 9 (12.5%) and 6 patients (8.3%), respectively, within a median follow-up of 18 months. The objective response rate was 79.1%. The overall cumulative 1-, 3-and 5-year survival rates and the median survival time were 38, 12 and 3% and 12.2 months, respectively. In group A, the overall cumulative 1-, 3-and 5-year survival rates were 56, 21 and 6%, respectively, with a median survival of 19 months; in group B, the overall cumulative 1-, 3-and 5-year survival rates were 23, 4 and 0%, respectively, with a median survival of 10.8 months (P=0.023). The treatment was well tolerated, with no severe radiation-induced liver disease and no reported > grade 3 toxicity. Tumor encapsulation was found to be a significant prognostic factor for survival. In conclusion, the combination of SBRT and TACE was shown to be a safe and effective treatment option for patients with unresectable huge HCC.

The challenge of inoperable hepatocellular carcinoma (HCC): results of a single-institutional experience on stereotactic body radiation therapy (SBRT)

“…Tumor size varied from 2 to 3 cm to approximately 5-7 cm. Only two studies treated lesions >10 cm with a moderate hypo-fractionation (Zhong et al 2014;Que et al 2014). The prescription dose (range 26-60 Gy) and the fractions number (range 3-10) were generally employed according to tumor size and liver function.…”

“…Most of the published studies enrolled both secondary and primary hepatic tumors, to investigate the efficacy of liver SBRT (Mendez Romero et al 2006;Tse et al 2008;Herfarth et al 2001;Goodman et al 2010;Dewas et al 2012). Since 2008, several retrospective reports on SBRT for HCC patients were published (Choi et al 2008;Kwon et al 2010;Seo et al 2010;Huang et al 2012;Xi et al 2013;Jacob et al 2014;Zhong et al 2014;Que et al 2014;Bibault et al 2013;Park et al 2013;Sanuki et al 2014a;Andolino et al 2011) with several biases. Patients number was small (ranged from 20 to 42) (Choi et al 2008;Kwon et al 2010;Seo et al 2010;Huang et al 2012;Xi et al 2013;Jacob et al 2014;Zhong et al 2014;Que et al 2014;Bibault et al 2013;Park et al 2013), and only one group figured out with more than 50 treated patients (185 included in that study) (Sanuki et al 2014a).…”

“…Several retrospective and prospective studies, focused on HCC patients, showed encouraging SBRT outcomes, with a local control rate of 66-100 % and overall survival rate of 52-100 %. A relatively low number of patients' recruitment was one of the biases, instead (Choi et al 2008;Kwon et al 2010;Seo et al 2010;Huang et al 2012;Xi et al 2013;Jacob et al 2014;Zhong et al 2014;Que et al 2014;Bibault et al 2013;Park et al 2013;Sanuki et al 2014a;Andolino et al 2011;Cardenes et al 2010;Kang et al 2012;Bujold et al 2012;Culleton et al 2014). This is a report from a prospective observational study on patients with inoperable HCC, treated with SBRT, according to lesions size and liver function.…”

Treatment Efficacy and Prognostic Factors for Huge HCC Based on Barcelona Clinic Liver Cancer Staging

“…Therefore, in the preoperative selection and evaluation, how to fully anticipate the difficulties and dangers of surgery to prepare vascular repair, maximize the retention of normal liver tissue, make use of the reasonable choice and the hepatic vascular exclusion, and minimize intra-operative bleeding squeeze and reduce surgical mortality and complications of surgical treatment of liver cancer are key points (Hironori et al, 2008;Yang et al, 2010;Yamashita et al, 2011;Zhong et al, 2014).…”

Prognostic Nomograms for Pre- and Postoperative Predictions of Long-Term Survival for Patients Who Underwent Liver Resection for Huge Hepatocellular Carcinoma

“…In addition, surgical resection for these patients is relatively difficult and the perioperative mortality and morbidity rates are still high. 11,12 As alternatives to hepatectomy are now available for huge HCC, 13 patients who are predicted to be unfavorable candidates for hepatectomy before surgery can choose other treatments. Therefore, a pre-operative prognostic prediction is essential to properly select patients for liver resection.…”