Radiat Oncol J.  2018 Jun;36(2):129-138. 10.3857/roj.2017.00598.

Is higher dose always the right answer in stereotactic body radiation therapy for small hepatocellular carcinoma?

• Lee KH
• Yu JI
• Park HC
• Park SY
• Shin JS
• Shin EH
• Cho S
• Jung SH
• Han YY
• Lim DH

• KMID: 2418873
• DOI: http://doi.org/10.3857/roj.2017.00598

Abstract

PURPOSE
This study was conducted to compare clinical outcomes and treatment-related toxicities after stereotactic body radiation therapy (SBRT) with two different dose regimens for small hepatocellular carcinomas (HCC) ≤3 cm in size.
MATERIALS AND METHODS
We retrospectively reviewed 44 patients with liver-confined HCC treated between 2009 and 2014 with SBRT. Total doses of 45 Gy (n = 10) or 60 Gy (n = 34) in 3 fractions were prescribed to the 95% isodose line covering 95% of the planning target volume. Rates of local control (LC), intrahepatic failure-free survival (IHFFS), distant metastasis-free survival (DMFS), and overall survival (OS) were calculated using the Kaplan-Meier method.
RESULTS
Median follow-up was 29 months (range, 8 to 64 months). Rates at 1 and 3 years were 97.7% and 95.0% for LC, 97.7% and 80.7% for OS, 76% and 40.5% for IHFFS, and 87.3% and 79.5% for DMFS. Five patients (11.4%) experienced degradation of albumin-bilirubin grade, 2 (4.5%) degradation of Child-Pugh score, and 4 (9.1%) grade 3 or greater laboratory abnormalities within 3 months after SBRT. No significant difference was seen in any oncological outcomes or treatment-related toxicities between the two dose regimens.
CONCLUSIONS
SBRT was highly effective for local control without severe toxicities in patients with HCC smaller than 3 cm. The regimen of a total dose of 45 Gy in 3 fractions was comparable to 60 Gy in efficacy and safety of SBRT for small HCC.

Keyword

Hepatocellular carcinoma; Stereotactic body radiotherapy; Dose fractionations

MeSH Terms

Carcinoma, Hepatocellular*
Dose Fractionation
Follow-Up Studies
Humans
Methods
Radiosurgery
Retrospective Studies