Nima Nabavizadeh1, Joseph G Waller2, Robert Fain3, Yiyi Chen4, Catherine R Degnin4, David A Elliott5, Brandon T Mullins6, Ishan A Patel7, Brandon A Dyer8, Kareem Fakhoury9, Willscott E Naugler10, Khashayar Farsad11, James A Tanyi12, Martin Fuss12, Charles R Thomas12, Arthur Y Hung11. 1. Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon. Electronic address: nabaviza@ohsu.edu. 2. Radiation Oncology Services, Atlanta, Georgia. 3. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. 4. Biostatistics Shared Resource, Oregon Health and Science University, Portland, Oregon. 5. Department of Radiation Oncology, University of Toledo, Toledo, Ohio. 6. Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina. 7. Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon. 8. Department of Radiation Oncology, University of California, Davis, California. 9. School of Medicine, Vanderbilt University, Nashville, Tennessee. 10. Division of Gastroenterology and Hepatology, Department of Medicine, Oregon Health and Science University, Portland, Oregon. 11. Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon. 12. Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon.
Abstract
PURPOSE: To report the toxicities and outcomes for stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy (AHRT) in patients with Child-Pugh (CP) class A, B, or C and albumin-bilirubin (ALBI) score 1, 2, or 3 hepatocellular carcinoma. METHODS AND MATERIALS: We retrospectively reviewed the data from 146 patients with hepatocellular carcinoma who had undergone SBRT (50 Gy in 5 fractions) or AHRT (45 Gy in 18 fractions). The primary endpoint was liver toxicity, defined as an increase in the CP score of ≥2 within 6 months of radiation therapy. The secondary endpoints of ALBI change, overall survival, and local control were also calculated. RESULTS: The median follow-up was 23 months (range 1-59). Most received SBRT (72%), and 28% received AHRT. Of all 146 patients, 45 (31%) had a CP score elevation of ≥2 within 6 months of radiation therapy (RT) (27 patients [28%] with baseline CP-A/B7 and 18 [35%] with baseline CP-B8/B9/C cirrhosis; P = .45). On multivariate analysis, neither baseline CP nor ALBI score was predictive of toxicity. No patient with a decline in liver functionality of CP ≥2 within 6 months of RT returned to baseline at later time points. Eleven grade 4 toxicities were observed. The mean change in the raw ALBI score at ∼6 months was similar for all baseline ALBI groups. Twenty-two patients underwent orthotopic liver transplantation after RT, 13 of whom had baseline CP-B8/B9/C liver functionality. For all patients, the 1- and 2-year treated-lesion local control was greater for SBRT than for AHRT (2-year 94% vs 65%, P < .0001). CONCLUSIONS: The tolerability of SBRT or AHRT as measured by a CP score decline of ≥2 within 6 months of RT was similar across baseline liver functionality groups. Compared with AHRT, SBRT was associated with superior local control. Because the true tolerability of limited-volume RT for patients with CP-B or CP-C cirrhosis is unknown, prospective trials validating its safety and efficacy are warranted.
PURPOSE: To report the toxicities and outcomes for stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy (AHRT) in patients with Child-Pugh (CP) class A, B, or C and albumin-bilirubin (ALBI) score 1, 2, or 3 hepatocellular carcinoma. METHODS AND MATERIALS: We retrospectively reviewed the data from 146 patients with hepatocellular carcinoma who had undergone SBRT (50 Gy in 5 fractions) or AHRT (45 Gy in 18 fractions). The primary endpoint was liver toxicity, defined as an increase in the CP score of ≥2 within 6 months of radiation therapy. The secondary endpoints of ALBI change, overall survival, and local control were also calculated. RESULTS: The median follow-up was 23 months (range 1-59). Most received SBRT (72%), and 28% received AHRT. Of all 146 patients, 45 (31%) had a CP score elevation of ≥2 within 6 months of radiation therapy (RT) (27 patients [28%] with baseline CP-A/B7 and 18 [35%] with baseline CP-B8/B9/C cirrhosis; P = .45). On multivariate analysis, neither baseline CP nor ALBI score was predictive of toxicity. No patient with a decline in liver functionality of CP ≥2 within 6 months of RT returned to baseline at later time points. Eleven grade 4 toxicities were observed. The mean change in the raw ALBI score at ∼6 months was similar for all baseline ALBI groups. Twenty-two patients underwent orthotopic liver transplantation after RT, 13 of whom had baseline CP-B8/B9/C liver functionality. For all patients, the 1- and 2-year treated-lesion local control was greater for SBRT than for AHRT (2-year 94% vs 65%, P < .0001). CONCLUSIONS: The tolerability of SBRT or AHRT as measured by a CP score decline of ≥2 within 6 months of RT was similar across baseline liver functionality groups. Compared with AHRT, SBRT was associated with superior local control. Because the true tolerability of limited-volume RT for patients with CP-B or CP-C cirrhosis is unknown, prospective trials validating its safety and efficacy are warranted.
Authors: Sun Hyun Bae; Hee Chul Park; Won Sup Yoon; Sang Min Yoon; In-Hye Jung; Ik Jae Lee; Jun Won Kim; Jinsil Seong; Tae Hyun Kim; Taek-Keun Nam; Youngmin Choi; Sun Young Lee; Hong Seok Jang; Dong Soo Lee; Jin Hee Kim Journal: Cancer Res Treat Date: 2019-04-10 Impact factor: 4.679
Authors: Shouyi Wei; Haibo Lin; J Isabelle Choi; Robert H Press; Stanislav Lazarev; Rafi Kabarriti; Carla Hajj; Shaakir Hasan; Arpit M Chhabra; Charles B Simone; Minglei Kang Journal: Front Oncol Date: 2022-01-13 Impact factor: 6.244