title: Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete transarterial chemoembolization.
abstract: BACKGROUND
  The objective of this study was to evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT) as a local salvage treatment after incomplete transarterial chemoembolization (TACE) for inoperable hepatocellular carcinoma (HCC).
  
  
  METHODS
  The main eligibility criteria were a greatest tumor dimension (LD sum) <10 cm, inoperable HCC, and incomplete response after TACE. Prescribed SBRT doses were up to 60 gray (Gy) in 3 fractions, but doses were reduced until normal tissue constraints were allowed.
  
  
  RESULTS
  Between May 2008 and February 2011, 50 patients were enrolled in this phase 2 trial, of which 47 patients were evaluable. Forty-one patients had Child-Pugh class A disease (A5/A6 were 32/9), 6 patients had class B7 disease, and 5 patients had portal vein tumor thrombosis. All patients underwent TACE 1 to 5 times before SBRT. SBRT doses ranged from 42 to 60 Gy in 3 fractions (median dose, 57 Gy), and the median LD sum was 29 mm (range, 13-78 mm). Eighteen patients (38.3%) achieved complete remission within 6 months of completing of SBRT, and 18 patients (38.3%) had a partial response. The 2-year local control rate was 94.6%, the overall survival rate was 68.7%, and the progression-free survival rate was 33.8%. Three patients (6.4%) experienced grade 3 gastrointestinal toxicity, and 2 patients (4.3%) experienced grade 4 gastric ulcer perforation.
  
  
  CONCLUSIONS
  This trial demonstrated that SBRT after incomplete TACE for inoperable HCC achieves promising rates of response and local control. On the basis of these study results, a modified, multi-institutional, phase 2 trial to reduce gastrointestinal toxicity is recommended.
authors.affiliation: Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
authors.forename: Jin-Kyu
authors.initials: JK
authors.lastname: Kang
authors.forename: Mi-Sook
authors.initials: MS
authors.lastname: Kim
authors.forename: Chul Koo
authors.initials: CK
authors.lastname: Cho
authors.forename: Kwang Mo
authors.initials: KM
authors.lastname: Yang
authors.forename: Hyung Jun
authors.initials: HJ
authors.lastname: Yoo
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Kim
authors.forename: Sun Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Da Hoon
authors.initials: DH
authors.lastname: Jung
authors.forename: Kum Bae
authors.initials: KB
authors.lastname: Kim
authors.forename: Dong Han
authors.initials: DH
authors.lastname: Lee
authors.forename: Chul Ju
authors.initials: CJ
authors.lastname: Han
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
authors.forename: Su Cheol
authors.initials: SC
authors.lastname: Park
authors.forename: Young Han
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents