Stereotactic body radiotherapy in hepatocellular carcinoma: patient selection and predictors of outcome and toxicity
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ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Stereotactic body radiotherapy in hepatocellular carcinoma: patient selection and predictors of outcome and toxicity Mauro Loi1 · Tiziana Comito1 · Ciro Franzese1,3 · Luca Dominici1,2 · Lorenzo Lo Faro1 · Elena Clerici1 · Davide Franceschini1 · Pietro Mancosu1 · Giacomo Reggiori1 · Pasqualina Gallo1 · Marco Badalamenti1,2,3 · Marta Scorsetti1,3 Received: 23 July 2020 / Accepted: 8 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Stereotactic Body Radiotherapy (SBRT) emerged as a valuable option in early to advanced-stage Hepatocellular Carcinoma (HCC) as defined by Barcelona Clinic Liver Cancer (BCLC) system. The aim of our study is to evaluate SBRT in HCC patients and to identify predictors of outcome and toxicity. Materials and methods A retrospective review of HCC patients treated at our Institution between November 2011 and December 2018 was carried out. SBRT was delivered in 3-10 fractions to a median Biologically Effective Dose ( BED10) of 103 Gy10. Results SBRT was performed in 128 patients to 217 HCC localizations, accounting for 142 treatment courses. BCLC stage was A, B, C in, respectively, 40 (31%), 72 (56%) and 16 (13%) patients. Local Control (LC), Progression Free Survival (PFS) and Overall Survival (OS) at 2 years were, respectively: 78%, 15% and 58%. LC was influenced by BED10 > 120 Gy10 (Hazard Ratio, HR: 0.08, 95% CI 0.01–0.59; p = 0.013) and size ≥ 3 cm (HR: 2.71, 95% CI 1.10–6.66; p = 0.03). BCLC stage was correlated to PFS (median 14 vs 12 vs 5 months, p = 0.012). In BCLC stage A-B disease (n = 112), LC was associated with improved survival (median 30 months vs not reached, p = 0.036). Acute and late toxicity rate was 26% (n = 37) and 8% (n = 11). Patients with BCLC B-C stage disease showed increased acute toxicity (HR: 2.9, 95% CI 1.10–7.65; p = 0.032). Conclusion Delivery of ablative doses > 120 Gy10 and tumor size are determinants of LC. Prolonged PFS and improved OS can be obtained in BCLC A-B patients. Grade 3 liver dysfunction is infrequent. Keywords Stereotactic radiotherapy · SBRT · SABR · Liver primary tumors · Hepatocellular carcinoma · Barcelona Clinic Liver Cancer System
Introduction Hepatocellular carcinoma (HCC) is the most common primary liver malignancy: while accounting for approximately 1 million cases per year, mainly located in Eastern Asia, HCC is the fourth cause of cancer related mortality * Mauro Loi [email protected] 1
Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
2
Radiotherapy Department, University of Florence, Florence, Italy
3
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
worldwide (Bray et al. 2018). Indication to treatment is based upon the extent of disease and baseline liver function, according to the Barcelona Clinic Liver Cancer (BCLC) staging system (Llovet et al. 1999). Early- stage HCC is potentially amenable to cura
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