Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma
Abstract Background To evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) in the treatment of advanced hepatocellular carcinoma (HCC). Material and Methods Patients with large HCCs (median diameter 7 cm, IQR 5-10 cm) with a Child-Turcotte-Pugh (CTP) score A (60%) or B (40%)...
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doaj-d07ee9eeb1644efabfe5bc4314be4b2c2020-11-24T21:11:48ZengBMCRadiation Oncology1748-717X2017-07-0112111110.1186/s13014-017-0851-7Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinomaEleni Gkika0Michael Schultheiss1Dominik Bettinger2Lars Maruschke3Hannes Philipp Neeff4Michaela Schulenburg5Sonja Adebahr6Simon Kirste7Ursula Nestle8Robert Thimme9Anca-Ligia Grosu10Thomas Baptist Brunner11Department of Radiation Oncology, University Medical CenterDepartment of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, University Medical CenterDepartment of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, University Medical CenterDepartment of Radiology, University Medical CenterDepartment of General and Visceral Surgery, University Medical CenterDepartment of Nuclear Medicine, University Medical CenterDepartment of Radiation Oncology, University Medical CenterDepartment of Radiation Oncology, University Medical CenterDepartment of Radiation Oncology, University Medical CenterDepartment of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, University Medical CenterDepartment of Radiation Oncology, University Medical CenterDepartment of Radiation Oncology, University Medical CenterAbstract Background To evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) in the treatment of advanced hepatocellular carcinoma (HCC). Material and Methods Patients with large HCCs (median diameter 7 cm, IQR 5-10 cm) with a Child-Turcotte-Pugh (CTP) score A (60%) or B (40%) and Barcelona-Clinic Liver Cancer (BCLC) classification stage B or C were treated with 3 to 12 fractions to allow personalized treatment according to the size of the lesions and the proximity of the lesions to the organs at risk aiming to give high biologically equivalent doses assuming an α/β ratio of 10 Gy for HCC. Primary end points were in-field local control and toxicity assessment. Results Forty seven patients with 64 lesions were treated with SBRT (median 45 Gy in 3–12 fractions) with a median follow up for patients alive of 19 months. The median biological effective dose was 76 Gy (IQR 62–86 Gy). Tumor vascular thrombosis was present in 28% and an underlying liver disease in 87% (hepatitis B or C in 21%, alcohol related in 51%, nonalcoholic steatohepatitis in 13% of the patients, primary biliary cirrhosis 2%). Eighty three percent received prior and in most cases multiple therapies. Local control at 1 year was 77%. The median overall survival from the start of SBRT was 9 months (95% CI 7.7–10.3). Gastrointestinal toxicities grade ≥ 2 were observed in 3 (6.4%) patients. An increase in CTP score without disease progression was observed in 5 patients, of whom one patient developed a radiation induced liver disease. One patient died due to liver failure 4 months after treatment. Conclusion SBRT is an effective local ablative therapy which leads to high local control rates with moderate toxicity for selected patients with large tumors.http://link.springer.com/article/10.1186/s13014-017-0851-7Stereotactic body radiotherapySBRTHepatocellular carcinomaHCCSIP |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Eleni Gkika Michael Schultheiss Dominik Bettinger Lars Maruschke Hannes Philipp Neeff Michaela Schulenburg Sonja Adebahr Simon Kirste Ursula Nestle Robert Thimme Anca-Ligia Grosu Thomas Baptist Brunner |
spellingShingle |
Eleni Gkika Michael Schultheiss Dominik Bettinger Lars Maruschke Hannes Philipp Neeff Michaela Schulenburg Sonja Adebahr Simon Kirste Ursula Nestle Robert Thimme Anca-Ligia Grosu Thomas Baptist Brunner Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma Radiation Oncology Stereotactic body radiotherapy SBRT Hepatocellular carcinoma HCC SIP |
author_facet |
Eleni Gkika Michael Schultheiss Dominik Bettinger Lars Maruschke Hannes Philipp Neeff Michaela Schulenburg Sonja Adebahr Simon Kirste Ursula Nestle Robert Thimme Anca-Ligia Grosu Thomas Baptist Brunner |
author_sort |
Eleni Gkika |
title |
Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma |
title_short |
Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma |
title_full |
Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma |
title_fullStr |
Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma |
title_full_unstemmed |
Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma |
title_sort |
excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma |
publisher |
BMC |
series |
Radiation Oncology |
issn |
1748-717X |
publishDate |
2017-07-01 |
description |
Abstract Background To evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) in the treatment of advanced hepatocellular carcinoma (HCC). Material and Methods Patients with large HCCs (median diameter 7 cm, IQR 5-10 cm) with a Child-Turcotte-Pugh (CTP) score A (60%) or B (40%) and Barcelona-Clinic Liver Cancer (BCLC) classification stage B or C were treated with 3 to 12 fractions to allow personalized treatment according to the size of the lesions and the proximity of the lesions to the organs at risk aiming to give high biologically equivalent doses assuming an α/β ratio of 10 Gy for HCC. Primary end points were in-field local control and toxicity assessment. Results Forty seven patients with 64 lesions were treated with SBRT (median 45 Gy in 3–12 fractions) with a median follow up for patients alive of 19 months. The median biological effective dose was 76 Gy (IQR 62–86 Gy). Tumor vascular thrombosis was present in 28% and an underlying liver disease in 87% (hepatitis B or C in 21%, alcohol related in 51%, nonalcoholic steatohepatitis in 13% of the patients, primary biliary cirrhosis 2%). Eighty three percent received prior and in most cases multiple therapies. Local control at 1 year was 77%. The median overall survival from the start of SBRT was 9 months (95% CI 7.7–10.3). Gastrointestinal toxicities grade ≥ 2 were observed in 3 (6.4%) patients. An increase in CTP score without disease progression was observed in 5 patients, of whom one patient developed a radiation induced liver disease. One patient died due to liver failure 4 months after treatment. Conclusion SBRT is an effective local ablative therapy which leads to high local control rates with moderate toxicity for selected patients with large tumors. |
topic |
Stereotactic body radiotherapy SBRT Hepatocellular carcinoma HCC SIP |
url |
http://link.springer.com/article/10.1186/s13014-017-0851-7 |
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