title: Hypofractionated stereotactic radiotherapy with and without transarterial chemoembolization for small hepatocellular carcinoma not eligible for other ablation therapies: Preliminary results for efficacy and toxicity.
abstract: OBJECTIVE
  To investigate the efficacy and toxicity of hypofractionated stereotactic radiotherapy for the treatment of patients presenting with hepatocellular carcinoma (HCC) in a single institutional setting.
  
  
  METHODS
  Sixteen patients who presented with solitary HCC, including two patients with a tumor thrombus of the portal veins, were treated with stereotactic radiotherapy with or without transarterial chemoembolization. The criteria for stereotactic radiotherapy were existence of technical difficulties for other ablation therapies, inoperable disease or refusal to undergo surgery, tumor staged as Grade A or B according to the Child-Pugh classification, and solitary tumor distant from the gastrointestinal tract and kidney with a tumor volume <100 cm(3). In 14 of 16 patients, a total dose of 35- 50 Gy was delivered in 5-7 fractions over 5-9 days.
  
  
  RESULTS
  At the end of a mean follow-up of 612 days (median 611 days; range 244-994 days), all patients were alive. Eight of 16 patients had complete responses and seven others were judged as stable with lipiodol accumulation. In one patient, local recurrence developed after 489 days. Intrahepatic recurrences developed outside the treated volume in six patients and no extrahepatic metastases developed during follow-up. No serious treatment-related toxic manifestations developed.
  
  
  CONCLUSIONS
  Stereotactic radiotherapy for HCC with or without transarterial chemoembolization is feasible therapy and provides good local control with a short treatment period. Stereotactic radiotherapy may be of clinical benefit in patients who are inoperable or for whom there are difficulties in other ablation therapies.
authors.affiliation: Department of Radiology, Ofuna Chuo Hospital, Kanagawa, and Department of Radiology, Hiroo Metropolitan General Hospital, Tokyo, Japan.
authors.forename: Atsuya
authors.initials: A
authors.lastname: Takeda
authors.forename: Masahiko
authors.initials: M
authors.lastname: Takahashi
authors.forename: Etsuo
authors.initials: E
authors.lastname: Kunieda
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takeda
authors.forename: Naoko
authors.initials: N
authors.lastname: Sanuki
authors.forename: Yuji
authors.initials: Y
authors.lastname: Koike
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Atsukawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Ohashi
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Saito
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Shigematsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kubo