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

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

doi:10.1007/s00066-024-02235-5

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

Strahlenther Onkol. 2024 Apr 30. doi: 10.1007/s00066-024-02235-5. Online ahead of print.

Authors

Ahmed Allam Mohamed^{1

2}, Marie-Luise Berres^{3

4}, Philipp Bruners^{5

4}, Sven Arke Lang^{6

4}, Christian Trautwein^{3

4}, Georg Wiltberger, Alexandra Barabasch, Michael Eble^{7

4}

Affiliations

¹ Radiation Oncology Department, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. amohamed@ukaachen.de.
² Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany. amohamed@ukaachen.de.
³ Gastroenterology, Hepatology and infectious Diseases Department, University Hospital RWTH Aachen, Aachen, Germany.
⁴ Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany.
⁵ Diagnostic and IInterventional Radiology Department, University Hospital RWTH Aachen, Aachen, Germany.
⁶ Visceral and Transplantation Surgery Department, University Hospital RWTH Aachen, Aachen, Germany.
⁷ Radiation Oncology Department, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.

PMID: 38689147
DOI: 10.1007/s00066-024-02235-5

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 (EQD2_α/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 EQD2_α/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.

Keywords: High-dose radiation therapy; Local ablative therapy; Non-invasive oncologic intervention; Precision Oncology; Primary liver cancer.