Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Review of a Local Hospital

Full Article

MHC Lam, HC Cheng, RKC Ngan

Hong Kong J Radiol 2017;20:205-12

DOI: 10.12809/hkjr1716902

Objective: To review the outcome and safety of stereotactic body radiation therapy (SBRT) for patients with hepatocellular carcinoma (HCC).
Methods: Patients who underwent SBRT for HCC between January 2013 and March 2016 at Queen Elizabeth Hospital were reviewed retrospectively. Tumour response and toxicities were evaluated. Local control and overall survival rates were calculated using the Kaplan-Meier method.

Results: 31 male and 8 female patients aged 54 to 90 (median, 72) years were included. 35 patients had Child-Pugh class A cirrhosis. 35 patients had viral hepatitis, of whom 33 were hepatitis B carriers. One patient was treatment naïve and underwent SBRT as bridging therapy prior to liver transplantation. The remaining 38 patients had received prior loco-regional therapies. The median tumour size was 1.9 cm. 29 patients had only one lesion. The SBRT doses ranged from 30 to 54 Gy in 6 to 7 fractions. After a median follow-up period of 17.8 months, 13 patients had died. The 1- and 2-year overall survival rates were 73.6% and 56.1%, respectively, and the median overall survival was 30.1 months. In 38 patients followed up at 3 months, 28.9%, 23.7%, and 42.1% had a complete response, partial response, and stable disease, respectively. The actuarial local control rate at 1 year was 82.8%. 21 patients had intrahepatic out-of-field recurrence, and four patients had distant metastasis. The 1-year intrahepatic recurrence-free survival was 50.5%, and the median intrahepatic recurrence-free survival was 15.4 months. 13 patients had grade 3 or above toxicity, of whom eight had thrombocytopaenia. One patient had grade 3 hepatic and renal toxicities and died after 2 months due to liver failure and hepatorenal syndrome.

Conclusion: SBRT is effective and safe even in previously treated patients. It results in good local control with minimal severe adverse events but a relatively high intrahepatic (out-of-field) recurrence rate.


Authors’ affiliations:
MHC Lam, HC Cheng, RKC Ngan: Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong









結果:共包括31名男性和8名女性患者,年齡介於54至90歲(中位數,72歲)。35名患者有Child-Pugh A型肝硬化。35名患者有病毒性肝炎,其中33名為乙型肝炎帶菌者。一名患者是初次治療,並應用SBRT治療為肝移植創造條件。其餘38名患者曾接受局部治療。中位腫瘤大小為1.9厘米。29名患者為單發腫瘤。SBRT劑量範圍為30至54 Gy分6至7次。中位隨訪17.8個月後,有13名患者死亡。1年和2年總體生存率分別為73.6%和56.1%,中位生存期為30.1個月。38名患者隨訪3個月後,28.9%、23.7%和42.1%分別達到完全緩解、部分緩解和病情穩定。1年精算局部控制率為82.8%。21名患者有肝內放療野外復發,4名患者有遠處轉移。1年肝內無復發生存率為50.5%,中位肝內無復發生存期為15.4個月。13名患者有3級或以上的毒性,其中8例為血小板減少症。一名患者出現三級肝腎毒性在2個月後死於肝功能衰竭和肝腎綜合徵。