Safety and Efficacy of Accelerated Hypofractionation and Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma Patients With Varying Degrees of Hepatic Impairment.

Abstract

PURPOSE:

To report the toxicities and outcomes for stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy (AHRT) in patients with Child-Pugh (CP) class A, B, or C and albumin-bilirubin (ALBI) score 1, 2, or 3 hepatocellular carcinoma.

METHODS AND MATERIALS:

We retrospectively reviewed the data from 146 patients with hepatocellular carcinoma who had undergone SBRT (50 Gy in 5 fractions) or AHRT (45 Gy in 18 fractions). The primary endpoint was liver toxicity, defined as an increase in the CP score of ≥2 within 6 months of radiation therapy. The secondary endpoints of ALBI change, overall survival, and local control were also calculated.

RESULTS:

The median follow-up was 23 months (range 1-59). Most received SBRT (72%), and 28% received AHRT. Of all 146 patients, 45 (31%) had a CP score elevation of ≥2 within 6 months of radiation therapy (RT) (27 patients [28%] with baseline CP-A/B7 and 18 [35%] with baseline CP-B8/B9/C cirrhosis; P = .45). On multivariate analysis, neither baseline CP nor ALBI score was predictive of toxicity. No patient with a decline in liver functionality of CP ≥2 within 6 months of RT returned to baseline at later time points. Eleven grade 4 toxicities were observed. The mean change in the raw ALBI score at ∼6 months was similar for all baseline ALBI groups. Twenty-two patients underwent orthotopic liver transplantation after RT, 13 of whom had baseline CP-B8/B9/C liver functionality. For all patients, the 1- and 2-year treated-lesion local control was greater for SBRT than for AHRT (2-year 94% vs 65%, P < .0001).

CONCLUSIONS:

The tolerability of SBRT or AHRT as measured by a CP score decline of ≥2 within 6 months of RT was similar across baseline liver functionality groups. Compared with AHRT, SBRT was associated with superior local control. Because the true tolerability of limited-volume RT for patients with CP-B or CP-C cirrhosis is unknown, prospective trials validating its safety and efficacy are warranted.

• Authors: Nima Nabavizadeh, Joseph G Waller, Robert Fain 3rd, Yiyi Chen, Catherine R Degnin, David A Elliott, Brandon T Mullins, Ishan A Patel, Brandon A Dyer, Kareem Fakhoury, Willscott E Naugler, Khashayar Farsad, James A Tanyi, Martin Fuss, Charles R Thomas Jr, Arthur Y Hung
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 100 Issue 3 Pg. 577-585 (03 01 2018) ISSN: 1879-355X [Electronic] United States
• PMID: 29413273 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Chemical References

• Albumins
• Bilirubin

Topics

• Albumins (analysis)
• Bilirubin (analysis)
• Carcinoma, Hepatocellular (radiotherapy)
• Female
• Follow-Up Studies
• Humans
• Liver (radiation effects)
• Liver Cirrhosis
• Liver Function Tests
• Liver Neoplasms (radiotherapy)
• Male
• Middle Aged
• Multivariate Analysis
• Organs at Risk
• Prognosis
• Radiation Dose Hypofractionation
• Radiosurgery (adverse effects, methods)
• Radiotherapy Dosage
• Retrospective Studies