J Korean Med Sci.  2013 Feb;28(2):213-219. 10.3346/jkms.2013.28.2.213.

Feasibility and Efficacy of Stereotactic Ablative Radiotherapy for Barcelona Clinic Liver Cancer-C Stage Hepatocellular Carcinoma

• Bae SH
• Kim MS
• Cho CK
• Kim KB
• Lee DH
• Han CJ
• Park SC
• Kim YH

• KMID: 1429183
• DOI: http://doi.org/10.3346/jkms.2013.28.2.213

Abstract

The purpose of this study was to assess the feasibility and efficacy of stereotactic ablative radiotherapy (SABR) for liver tumor in patients with Barcelona Clinic Liver Cancer (BCLC)-C stage hepatocellular carcinoma (HCC). We retrospectively reviewed the medical records of 35 patients between 2003 and 2011. Vascular invasion was diagnosed in 32 patients, extrahepatic metastases in 11 and both in 8. Thirty-two patients were categorized under Child-Pugh (CP) class A and 3 patients with CP class B. The median SABR dose was 45 Gy (range, 30-60 Gy) in 3-5 fractions. The median survival time was 14 months. The 1- and 3-yr overall survival (OS) rate was 52% and 21%, respectively. On univariate analysis, CP class A and biologically equivalent dose > or = 80 Gy10 were significant determinants of better OS. Severe toxicity above grade 3, requiring prompt therapeutic intervention, was observed in 5 patients. In conclusion, SABR for BCLC-C stage HCC showed 1-yr OS rate of 52% but treatment related toxicity was moderate. We suggest that patients with CP class A are the best candidate and at least SABR dose of 80 Gy10 is required for BCLC-C stage.

Keyword

Carcinoma; Hepatocellular; Neoplasm Staging; Radiotherapy; Stereotactic Techniques

MeSH Terms

Adult
Aged
Carcinoma, Hepatocellular/mortality/*radiotherapy
Feasibility Studies
Female
Follow-Up Studies
Humans
Liver Failure/etiology
Liver Neoplasms/mortality/*radiotherapy
Male
Middle Aged
Myelitis/etiology
Neoplasm Staging
Prognosis
Radiation Dosage
Retrospective Studies
Severity of Illness Index
Stereotaxic Techniques
Survival Rate

Figure

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  Fig. 1 Treatment algorithm of hepatocellular carcinoma in Korea, proposed by Korean Liver Cancer Study Group and National Cancer Center.

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  Fig. 2 Overall survival rate of all patients with Barcelona Clinic Liver Cancer-C stage hepatocellular carcinoma treated with stereotactic ablative radiotherapy.

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  Fig. 3 Overall survival rates according to Child-Pugh (CP) class (A) and Biologically equivalent dose (BED), assuming that α/β was 10 Gy (B).

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