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Strahlentherapie und Onkologie

Open Access 30-04-2024 | Hepatocellular Carcinoma | Original Article

Managing hepatocellular carcinoma across the stages: efficacy and outcomes of stereotactic body radiotherapy

A retrospective study

Authors: Ahmed Allam Mohamed, Marie-Luise Berres, Philipp Bruners, Sven Arke Lang, Christian Trautwein, Georg Wiltberger, Alexandra Barabasch, Michael Eble

Published in: Strahlentherapie und Onkologie

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Abstract

Purpose

Hepatocellular carcinoma (HCC) poses a unique challenge due to its predilection for developing on compromised livers, often limiting surgical options. Stereotactic body radiotherapy (SBRT) has emerged as a promising local treatment modality for HCC. This study aims to assess the effectiveness of SBRT in HCC patients not suitable for surgery, focusing on local control, optimal radiation dosing, and prognostic factors.

Methods

In this retrospective analysis, 52 HCC patients treated with SBRT were examined. The study assessed local control, progression-free survival (PFS), and overall survival (OS) while conducting dosimetric analyses. The relationship between mean liver dose and Child–Pugh score (CPS) progression was also explored.

Results

SBRT demonstrated 93.4% freedom from local progression (FFLP) at 12 months. Notably, a near minimum dose (D98%) below 61 Gy as an equivalent dose in 2‑Gy fractions with α/β 10 Gy (EQD2α/β10) was associated with reduced FFLP (p-value 0.034). Logistic regression analysis revealed a dose–response relationship for FFLP and D98% with 95% and 98% probability of FFLP at a dose of 56.9 and 73.1 Gy, respectively. The study observed OS rates of 63.7% at 1 year and 34.3% at 3 years. Patients with portal vein tumor thrombus (PVTT) and larger tumors (≥ 37 cm3) experienced decreased PFS and OS. Multivariate analysis identified PVTT, larger tumor volume, and performance status as independent predictors of reduced OS. Notably, classical radiation-induced disease (cRILD) was absent, but nonclassical (nc) RILD occurred in 7.7% of patients. Regression analysis linked a mean EQD2α/β3–8 dose to the liver (12.8–12.6) with a 10% likelihood of ncRILD.

Conclusion

SBRT offers a compelling option for achieving high local control and promising survival outcomes in HCC. The study supports a radiation dose range of 61–73.1 Gy, coupled with a mean liver dose under 12.6–12.8 Gy as EQD2, to achieve favorable FFLP rates, with acceptable toxicity rates.
Appendix
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Metadata
Title
Managing hepatocellular carcinoma across the stages: efficacy and outcomes of stereotactic body radiotherapy
A retrospective study
Authors
Ahmed Allam Mohamed
Marie-Luise Berres
Philipp Bruners
Sven Arke Lang
Christian Trautwein
Georg Wiltberger
Alexandra Barabasch
Michael Eble
Publication date
30-04-2024
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-024-02235-5