Managing hepatocellular carcinoma (HCC) across the stages: Efficacy and outcomes of stereotactic body radiotherapy (SBRT), a retrospective study

Abstract

Abstract Purpose: Hepatocellular carcinoma (HCC) poses a unique challenge due to its predilection for developing a compromised liver, 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 unsuitable 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 a remarkable 95.7% freedom from local progression (FFLP) at 12 months. Notably, a D98% below 61 Gy (EQD2 α/ β 10) was associated with reduced FFLP (p-value 0.055). Logistic regression analysis revealed a dose-response relationship, with a 98% probability of tumor control at a prescribed radiation dose of 73.1 Gy. The study observed OS rates of 63.9% at one year and 32.8% at three 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, c-RILD was absent, but ncRILD occurred in 7.7% of patients. Regression analysis linked a mean EQD2 α/ β 3 dose to the liver 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 Gy as EQD2, to achieve favorable FFLP rates with acceptable toxicity rates.