title: Pilot study of stereotactic body radiotherapy for huge hepatocellular carcinoma unsuitable for other therapies.
abstract: OBJECTIVE
  To determine the feasibility and efficacy of stereotactic body radiotherapy (SBRT) for huge hepatocellular carcinoma unsuitable for other therapies.
  
  
  METHODS
  Six patients with very large hepatocellular carcinomas (>10 cm) unsuitable for surgical resection or that failed to respond to transcatheter arterial chemoembolization (TACE) were treated by SBRT. Doses ranged from 32 Gy to 40 Gy in four fractions. Survival, response, and toxicities were evaluated.
  
  
  RESULTS
  After a median follow-up of 25.9 months (range 8.1-56 months), three patients had died and three were alive. Overall, treatment was well tolerated and no dose-limiting toxicity or radiation-induced liver disease was observed. The median survival was 10 months (range 3-56 months) and the median progression-free duration was 6 months (range, 2-21 months). Partial response was achieved by four patients, stable disease by one, and one patient had disease progression. One patient with a partial response who underwent lobectomy after SBRT was alive 56 months post-SBRT.
  
  
  CONCLUSIONS
  This study suggests that SBRT can be delivered safely at 32-40 Gy in four fractions to huge hepatocellular carcinoma. Furthermore, combinations of SBRT with other modalities such as surgery or TACE might prolong survival.
authors.affiliation: Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Shin
authors.forename: Mi-Sook
authors.initials: MS
authors.lastname: Kim
authors.forename: Seong Yul
authors.initials: SY
authors.lastname: Yoo
authors.forename: Chul Koo
authors.initials: CK
authors.lastname: Cho
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Jin-kyu
authors.initials: JK
authors.lastname: Kang
authors.forename: Su Cheol
authors.initials: SC
authors.lastname: Park
authors.forename: Chul Ju
authors.initials: CJ
authors.lastname: Han
authors.forename: Sang Beom
authors.initials: SB
authors.lastname: Kim
authors.forename: Byong Hee
authors.initials: BH
authors.lastname: Lee
authors.forename: Dong Han
authors.initials: DH
authors.lastname: Lees
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000532:radiotherapy*; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D016634:Radiosurgery / Q000009:adverse effects; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome