title: Two-week schedule of hypofractionated radiotherapy as a local salvage treatment for small hepatocellular carcinoma.
abstract: OBJECTIVE
  In cases of small hepatocellular carcinoma (HCC) where established curative treatment cannot be applied, stereotactic body radiotherapy (SBRT) has been used as a non-invasive alternative treatment modality. However, short-course SBRT may not be safe if the tumor is located around a critical normal organ. Therefore, we applied hypofractionated radiotherapy for these tumors and evaluated outcomes of this treatment.
  
  
  METHODS
  Between December 2008 and August 2011, 26 patients (28 lesions) with HCC were treated with hypofractionated radiotherapy. Inclusion criteria were HCC not suitable for surgery or other local ablative therapy, a tumor size < 6 cm, adequate hepatic function, an HCC located within 2 cm of a critical organ, and no evidence of vascular invasion. A dose of 4-5 Gy per fraction was given, with a total dose of 40-50 Gy over 2 weeks.
  
  
  RESULTS
  The overall response rate was 67.9%, with seven complete responses (25.0%) and 12 partial responses (42.9%) at 3 months after radiotherapy. The overall survival rates at 1 and 2 years were 88.5% and 67.2%, respectively. The local control rate at 2 years was 87.6%. The Intrahepatic recurrence-free and distant failure-free survival rates at 2 years were 36.5% and 68.2%, respectively. Grade ≥ 3 hepatic toxicity was observed in one patient.
  
  
  CONCLUSIONS
  Two-week schedule of hypofractionated radiotherapy for small HCC was feasible with good local control and safety. This fractionation schedule can be used as an alternative treatment option for HCC located close to a critical normal organ if short-course SBRT is not feasible.
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Park
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Yoon
authors.forename: Young-Suk
authors.initials: YS
authors.lastname: Lim
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Ju Hyun
authors.initials: JH
authors.lastname: Shim
authors.forename: Kang Mo
authors.initials: KM
authors.lastname: Kim
authors.forename: Han Chu
authors.initials: HC
authors.lastname: Lee
authors.forename: Byungchul
authors.initials: B
authors.lastname: Cho
authors.forename: Geumju
authors.initials: G
authors.lastname: Park
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods* / Q000401:mortality; D016879:Salvage Therapy; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: hepatocellular carcinoma; hypofractionated radiotherapy; local control; salvage