TY - JOUR
T1 - Definitive Stereotactic Body Radiation Therapy in Early-Stage Solitary Hepatocellular Carcinoma
T2 - An Australian Multi-Institutional Review of Outcomes
AU - Liu, H. Y.H.
AU - Lee, Y. Y.D.
AU - Sridharan, S.
AU - Wang, W.
AU - Khor, R.
AU - Chu, J.
AU - Oar, A.
AU - Choong, E. S.
AU - Le, H.
AU - Shanker, M.
AU - Wigg, A.
AU - Stuart, K.
AU - Pryor, D.
PY - 2023/12
Y1 - 2023/12
N2 - Aims: Standard curative options for early-stage, solitary hepatocellular carcinoma (HCC) are often unsuitable due to liver dysfunction, comorbidities and/or tumour location. Stereotactic body radiation therapy (SBRT) has shown high rates of local control in HCC; however, limited data exist in the treatment-naïve, curative-intent setting. We report the outcomes of patients with solitary early-stage HCC treated with SBRT as first-line curative-intent therapy. Materials and methods: A multi-institutional retrospective study of treatment-naïve patients with Barcelona Clinic Liver Cancer stage 0/A, solitary ≤5 cm HCC, Child-Pugh score (CPS) A liver function who underwent SBRT between 2010 and 2019 as definitive therapy. The primary end point was freedom from local progression. Secondary end points were progression-free survival, overall survival, rate of treatment-related clinical toxicities and change in CPS >1. Results: In total, 68 patients were evaluated, with a median follow-up of 20 months (range 3–58). The median age was 68 years (range 50–86); 54 (79%) were men, 62 (91%) had cirrhosis and 50 (74%) were Eastern Cooperative Oncology Group 0. The median HCC diameter was 2.5 cm (range 1.3–5) and the median prescription biologically effective dose with a tumour a/b ratio of 10 Gy (BED10) was 93 Gy (interquartile range 72–100 Gy). Two-year freedom from local progression, progression-free survival and overall survival were 94.3% (95% confidence interval 86.6–100%), 59.5% (95% confidence interval 46.3–76.4%) and 88% (95% confidence interval 79.2–97.6%), respectively. Nine patients (13.2%) experienced grade ≥2 treatment-related clinical toxicities. A rise >1 in CPS was observed in six cirrhotic patients (9.6%). Conclusion: SBRT is an effective and well-tolerated option to consider in patients with solitary, early-stage HCC. Prospective, randomised comparative studies are warranted to further refine its role as a first-line curative-intent therapy.
AB - Aims: Standard curative options for early-stage, solitary hepatocellular carcinoma (HCC) are often unsuitable due to liver dysfunction, comorbidities and/or tumour location. Stereotactic body radiation therapy (SBRT) has shown high rates of local control in HCC; however, limited data exist in the treatment-naïve, curative-intent setting. We report the outcomes of patients with solitary early-stage HCC treated with SBRT as first-line curative-intent therapy. Materials and methods: A multi-institutional retrospective study of treatment-naïve patients with Barcelona Clinic Liver Cancer stage 0/A, solitary ≤5 cm HCC, Child-Pugh score (CPS) A liver function who underwent SBRT between 2010 and 2019 as definitive therapy. The primary end point was freedom from local progression. Secondary end points were progression-free survival, overall survival, rate of treatment-related clinical toxicities and change in CPS >1. Results: In total, 68 patients were evaluated, with a median follow-up of 20 months (range 3–58). The median age was 68 years (range 50–86); 54 (79%) were men, 62 (91%) had cirrhosis and 50 (74%) were Eastern Cooperative Oncology Group 0. The median HCC diameter was 2.5 cm (range 1.3–5) and the median prescription biologically effective dose with a tumour a/b ratio of 10 Gy (BED10) was 93 Gy (interquartile range 72–100 Gy). Two-year freedom from local progression, progression-free survival and overall survival were 94.3% (95% confidence interval 86.6–100%), 59.5% (95% confidence interval 46.3–76.4%) and 88% (95% confidence interval 79.2–97.6%), respectively. Nine patients (13.2%) experienced grade ≥2 treatment-related clinical toxicities. A rise >1 in CPS was observed in six cirrhotic patients (9.6%). Conclusion: SBRT is an effective and well-tolerated option to consider in patients with solitary, early-stage HCC. Prospective, randomised comparative studies are warranted to further refine its role as a first-line curative-intent therapy.
KW - Curative intent
KW - Hepatocellular carcinoma
KW - Stereotactic ablative radiation therapy
KW - Stereotactic body radiation therapy
UR - http://www.scopus.com/inward/record.url?scp=85170661449&partnerID=8YFLogxK
U2 - 10.1016/j.clon.2023.08.012
DO - 10.1016/j.clon.2023.08.012
M3 - Article
AN - SCOPUS:85170661449
SN - 0936-6555
VL - 35
SP - 787
EP - 793
JO - Clinical Oncology
JF - Clinical Oncology
IS - 12
ER -
