Stereotactic body radiation therapy for centrally located hepatocellular carcinoma: outcomes and toxicities

Stanislav Lazarev, Camille Hardy-Abeloos, Oren Factor, Kenneth Rosenzweig, Michael Buckstein

To examine safety and efficacy of stereotactic body radiation therapy (SBRT) for centrally located hepatocellular carcinoma (CL-HCC). Fifty-three patients with CL-HCC were treated with SBRT from 2011 to 2017 in our institution. CL-HCC was defined as a tumor sited in segments 4, 5, or 8 adjacent to the hepatic hilum, or < 1.5 cm from main portal branches. Primary endpoints were treatment response, local control (LC), and hepatobiliary toxicity (HBT). Thirty-three (62.3%) patients had Child-Turcotte-Pugh score A, 20 (37.77%)-score B. Albumin-bilirubin grade 1 constituted 6 (11.3%) cases, grade 2-32 (60.4%), grade 3-15 (28.3%). Median tumor diameter was 34 mm. Median BED10 was 72 Gy. Complete/partial response was observed in 40 (75.5%) lesions, stable disease-in 9 (17.0%). At a median follow-up of 12.2 months, there were 6 (11.3%) local failures. The actuarial 2-year LC rate was 87.9%. 2-year LC was better with higher BED10 (> 70 vs ≤ 70 Gy) 96.9 vs 72.5%, p = 0.01. The 2-year rates for disease-specific and overall survival were 53.2 and 39.1%, respectively. The incidence of any Grade ≥ 3 AE was 9 (17.0%). There were no grade 5 AEs. There was a trend toward an increased risk of grade ≥ 3 AE with mean liver dose > 10 Gy (p = 0.07). In the present cohort, SBRT to the CL-HCC produced excellent treatment response with acceptable HBT and LC. Select HCC patients who are not candidates for surgery or other locoregional therapies can be considered for SBRT to the central liver.