Clinical outcomes with combination of stereotactic body radiation therapy in patients with hepatocellular carcinoma

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PURPOSE: The purpose of the present study was to evaluate outcomes with a combination of stereotactic body radiation therapy (SBRT) for patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The present retrospective study included 46 patients with 1-3 liver lesions with portal vein tumor thrombosis (PVTT) in 27 treated with definitive, consolidative, or salvage SBRT. The patients had Barcelona Clinic Liver Cancer (BCLC) stage A, B, or C disease (n = 44) with new, residual, progressive, or recurrent lesions with prior liver-directed and/or systemic therapy (n = 37). The median combined maximum diameter of the lesions was 7.48 cm (range, 1.55-16.5 cm). The dose fractionation for SBRT was 24-50 Gy in 5-8 fractions (median = 30 Gy in 6 fractions) with volumetric modulated arc technique on linear accelerator. Systemic treatment with sorafenib, lenvatinib, and/or nivolumab was given in 35 patients. Liver-directed interventional treatment after SBRT was given in 10 patients. Treatment response was evaluated as per mRECIST with or without Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST), and Kaplan-Meier survival analysis was performed. RESULTS: Patient-reported relief in symptoms was observed in 59.4% after SBRT. Of 46, 27 (58.7%) had decreased serum tumor markers with AFP and/or PIVKA-II at 3 months after SBRT with systemic treatment. The median overall survival (OS) was 21.4 months (95% CI: 14.3-28.5 months) after the index cancer diagnosis. The 6-month, 1-year, 2-year, and 3-year OS rates after diagnosis were 84.8%, 60.6%, 44.7%, and 28.2%, respectively. The median OS was 25.3 months versus 10.9 months in patients without versus with PVTT, respectively. Early response at 3-4 months after SBRT with systemic therapy (complete or partial (n = 29) versus stable or progressive (n = 17)) showed an independent association with OS (P ≤ 0.001, hazard ratio (HR) 3.88, 95% CI: 1.94-7.77). The estimated 1-year and 2-year local control rates in all patients were 94.1% and 89.6% after SBRT with systemic therapy. One patient had conversion surgery. Grade 3 hepatic toxicity during SBRT was 10.9%. Liver dysfunction with a Child-Pugh score of 2 or more points within 3 months after SBRT with systemic therapy was noted in 27.3% of patients. Late gastrointestinal toxicity was observed in 1 patient (2.17%). CONCLUSION: The present study suggested that a combination of radiotherapy with other liver-directed and/or systemic treatments is associated with favorable disease control and prolongation of survival in patients with early to advanced-stage HCC.

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