Definitive Stereotactic Body Radiation Therapy in Early-Stage Solitary Hepatocellular Carcinoma: An Australian Multi-Institutional Review of Outcomes

H Y-H Liu; Y-Y D Lee; S Sridharan; W Wang; R Khor; J Chu; A Oar; E S Choong; H Le; M Shanker; A Wigg; K Stuart; D Pryor

doi:10.1016/j.clon.2023.08.012

Definitive Stereotactic Body Radiation Therapy in Early-Stage Solitary Hepatocellular Carcinoma: An Australian Multi-Institutional Review of Outcomes

Clin Oncol (R Coll Radiol). 2023 Dec;35(12):787-793. doi: 10.1016/j.clon.2023.08.012. Epub 2023 Sep 5.

Authors

H Y-H Liu¹, Y-Y D Lee², S Sridharan³, W Wang⁴, R Khor⁵, J Chu⁶, A Oar⁷, E S Choong⁸, H Le⁹, M Shanker², A Wigg¹⁰, K Stuart¹¹, D Pryor²

Affiliations

¹ Department of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Queensland, Australia. Electronic address: howard.liu@health.qld.gov.au.
² Department of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Queensland, Australia.
³ Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia.
⁴ Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia; Department of Radiation Oncology, Nepean Cancer Care Centre, Kingswood, New South Wales, Australia.
⁵ Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.
⁶ Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁷ Icon Cancer Centre, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
⁸ Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
⁹ Department of Radiation Oncology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
¹⁰ Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
¹¹ Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.

PMID: 37709623
DOI: 10.1016/j.clon.2023.08.012

Abstract

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.

Keywords: Curative intent; Hepatocellular carcinoma; Stereotactic ablative radiation therapy; Stereotactic body radiation therapy.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Australia / epidemiology
Carcinoma, Hepatocellular* / surgery
Female
Humans
Liver Neoplasms* / surgery
Male
Middle Aged
Prospective Studies
Radiosurgery* / adverse effects
Retrospective Studies
Treatment Outcome