title: Stereotactic body radiotherapy for primary hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) for the treatment of primary hepatocellular carcinoma (HCC).
  
  
  METHODS
  From 2005 to 2009, 60 patients with liver-confined HCC were treated with SBRT at the Indiana University Simon Cancer Center: 36 Child-Turcotte-Pugh (CTP) Class A and 24 CTP Class B. The median number of fractions, dose per fraction, and total dose, was 3, 14 Gy, and 44 Gy, respectively, for those with CTP Class A cirrhosis and 5, 8 Gy, and 40 Gy, respectively, for those with CTP Class B. Treatment was delivered via 6 to 12 beams and in nearly all cases was prescribed to the 80% isodose line. The records of all patients were reviewed, and treatment response was scored according to Response Evaluation Criteria in Solid Tumors v1.1. Toxicity was graded according to the Common Terminology Criteria for Adverse Events v4.0. Local control (LC), time to progression (TTP), progression-free survival (PFS), and overall survival (OS) were calculated according to the method of Kaplan and Meier.
  
  
  RESULTS
  The median follow-up time was 27 months, and the median tumor diameter was 3.2 cm. The 2-year LC, PFS, and OS were 90%, 48%, and 67%, respectively, with median TTP of 47.8 months. Subsequently, 23 patients underwent transplant, with a median time to transplant of 7 months. There were no ≥Grade 3 nonhematologic toxicities. Thirteen percent of patients experienced an increase in hematologic/hepatic dysfunction greater than 1 grade, and 20% experienced progression in CTP class within 3 months of treatment.
  
  
  CONCLUSIONS
  SBRT is a safe, effective, noninvasive option for patients with HCC ≤6 cm. As such, SBRT should be considered when bridging to transplant or as definitive therapy for those ineligible for transplant.
authors.affiliation: Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. dandolin@iupui.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Andolino
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.forename: Mary
authors.initials: M
authors.lastname: Maluccio
authors.forename: Paul
authors.initials: P
authors.lastname: Kwo
authors.forename: A Joseph
authors.initials: AJ
authors.lastname: Tector
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zook
authors.forename: Peter A S
authors.initials: PA
authors.lastname: Johnstone
authors.forename: Higinia R
authors.initials: HR
authors.lastname: Cardenes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017321:Clinical Trials, Phase I as Topic; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D007668:Kidney / Q000528:radiation effects; D008103:Liver Cirrhosis / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013116:Spinal Cord / Q000528:radiation effects; D047368:Tumor Burden; D055815:Young Adult