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Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete transarterial chemoembolization
Article first published online: 8 MAY 2012
Copyright © 2012 American Cancer Society
Volume 118, Issue 21, pages 5424–5431, 1 November 2012
How to Cite
Kang, J.-K., Kim, M.-S., Cho, C. K., Yang, K. M., Yoo, H. J., Kim, J. H., Bae, S. H., Jung, D. H., Kim,, K. B., Lee, D. H., Han, C. J., Kim, J., Park, S. C. and Kim, Y. H. (2012), Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete transarterial chemoembolization. Cancer, 118: 5424–5431. doi: 10.1002/cncr.27533
- Issue published online: 19 OCT 2012
- Article first published online: 8 MAY 2012
- Manuscript Accepted: 14 FEB 2012
- Manuscript Revised: 26 JAN 2012
- Manuscript Received: 5 DEC 2011
- hepatocellular carcinoma;
- stereotactic body radiation therapy;
- transarterial chemoembolization;
- response rate;
- phase 2 trial
The objective of this study was to evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT) as a local salvage treatment after incomplete transarterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC).
The main eligibility criteria were a greatest tumor dimension (LD sum) <10 cm, inoperable HCC, and incomplete response after TACE. Prescribed SBRT doses were up to 60 gray (Gy) in 3 fractions, but doses were reduced until normal tissue constraints were allowed.
Between May 2008 and February 2011, 50 patients were enrolled in this phase 2 trial, of which 47 patients were evaluable. Forty-one patients had Child-Pugh class A disease (A5/A6 were 32/9), 6 patients had class B7 disease, and 5 patients had portal vein tumor thrombosis. All patients underwent TACE 1 to 5 times before SBRT. SBRT doses ranged from 42 to 60 Gy in 3 fractions (median dose, 57 Gy), and the median LD sum was 29 mm (range, 13-78 mm). Eighteen patients (38.3%) achieved complete remission within 6 months of completing of SBRT, and 18 patients (38.3%) had a partial response. The 2-year local control rate was 94.6%, the overall survival rate was 68.7%, and the progression-free survival rate was 33.8%. Three patients (6.4%) experienced grade 3 gastrointestinal toxicity, and 2 patients (4.3%) experienced grade 4 gastric ulcer perforation.
This trial demonstrated that SBRT after incomplete TACE for inoperable HCC achieves promising rates of response and local control. On the basis of these study results, a modified, multi-institutional, phase 2 trial to reduce gastrointestinal toxicity is recommended. Cancer 2012. © 2012 American Cancer Society.