Liver stereotactic radiotherapy (SRT) with functional treatment planning for patients with intermediate stage hepatocellular carcinoma (HCC)

Abstract

Objective

The objective of this study was to analyze hepatic failure progression and survival in patients with Barcelona Clinic Liver Cancer (BCLC) A3-B hepatocellular carcinoma (HCC) after stereotactic radiotherapy (SRT) with functional treatment planning.

Methods

Liver SPECT was co-registered to 4DCT for avoidance of functional liver during SRT planning. Liver dose constraints/fractionation was based on functional liver volume. Concurrent capecitabine was administered for fraction size ≤ 4 Gy. Hepatic function, toxicity, and radiographic response were documented q4–6 months following radiotherapy.

Results

Twenty-two patients (14 Child-Pugh A, 8 Child-Pugh B Cirrhosis) with 39 lesions were analyzed. Fourteen patients received SBRT (mean dose 44.7 Gy, 5–6 fractions). Eight patients received SRT and concurrent capecitabine (mean dose 40.7 Gy, 14–18 fractions). Mean follow-up was 20 months. Nine patients developed grade ≤ 2 transient elevation of liver enzymes. At 24 months, Child-Pugh class was stable in 59% patients and MELD progression free survival was 76%. No RILD or accelerated hepatic failure was observed. In-field local control was 97.4% and overall survival was 59% at 2 years.

Conclusions

Liver SRT with functional treatment planning is safe in intermediate hepatocellular carcinoma. Liver failure is not hastened despite the inclusion of 36% Child-Pugh B patients.

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