title: Stereotactic body radiation therapy in recurrent hepatocellular carcinoma.
abstract: OBJECTIVE
  To examine the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients of recurrent hepatocellular carcinoma (HCC).
  
  
  METHODS
  This was a matched-pair study. From January 2008 to December 2009, 36 patients with 42 lesions of unresectable recurrent HCC were treated with SBRT. The median prescribed dose was 37 Gy (range, 25 to 48 Gy) in 4-5 fractions over 4-5 consecutive working days. Another 138 patients in the historical control group given other or no treatments were selected for matched analyses.
  
  
  RESULTS
  The median follow-up time was 14 months for all patients and 20 months for those alive. The 1- and 2-year in-field failure-free rates were 87.6% and 75.1%, respectively. Out-field intrahepatic recurrence was the main cause of failure. The 2-year overall survival (OS) rate was 64.0%, and median time to progression was 8.0 months. In the multivariable analysis of all 174 patients, SBRT (yes vs. no), tumor size (≤4 cm vs. >4 cm), recurrent stage (stage IIIB/IV vs. I) and Child-Pugh classification (A vs. B/C) were independent prognostic factors for OS. Matched-pair analysis revealed that patients undergoing SBRT had better OS (2-year OS of 72.6% vs. 42.1%, respectively, p = 0.013). Acute toxicities were mild and tolerable.
  
  
  CONCLUSIONS
  SBRT is a safe and efficacious modality and appears to be well-tolerated at the dose fractionation we have used, and its use correlates with improved survival in this cohort of patients with recurrent unresectable HCC. Out-field recurrence is the major cause of failure. Further studies of combinations of SBRT and systemic therapies may be reasonable.
authors.affiliation: Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Wen-Yen
authors.initials: WY
authors.lastname: Huang
authors.forename: Yee-Min
authors.initials: YM
authors.lastname: Jen
authors.forename: Meei-Shyuan
authors.initials: MS
authors.lastname: Lee
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Chang
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Chen
authors.forename: Kai-Hsiung
authors.initials: KH
authors.lastname: Ko
authors.forename: Kuen-Tze
authors.initials: KT
authors.lastname: Lin
authors.forename: Jang-Chun
authors.initials: JC
authors.lastname: Lin
authors.forename: Hsing-Lung
authors.initials: HL
authors.lastname: Chao
authors.forename: Chun-Shu
authors.initials: CS
authors.lastname: Lin
authors.forename: Yu-Fu
authors.initials: YF
authors.lastname: Su
authors.forename: Chao-Yueh
authors.initials: CY
authors.lastname: Fan
authors.forename: Yao-Wen
authors.initials: YW
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D057918:Fiducial Markers; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000528:radiation effects; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011832:Radiation Injuries / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D047368:Tumor Burden