title: The efficacy of stereotactic body radiation therapy on huge hepatocellular carcinoma unsuitable for other local modalities.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients with unresectable huge hepatocellular carcinoma (HCC) unsuitable of other standard treatment option.
  
  
  METHODS
  Between 2009 and 2011, 22 patients with unresectable huge HCC (≧10 cm) were treated with SBRT. dose ranged from 26 Gy to 40 Gy in five fractions. Overall survival (OS) and disease-progression free survival (DPFS) were determined by Kaplan-Meier analysis. Tumor response and toxicities were also assessed.
  
  
  RESULTS
  After a median follow-up of 11.5 month (range 2-46 months). The objective response rate was achieved in 86.3% (complete response (CR): 22.7% and partial response (PR): 63.6%). The 1-yr. local control rate was 55.56%. The 1-year OS was 50% and median survival was 11 months (range 2-46 months). In univariate analysis, Child-Pugh stage (p = 0.0056) and SBRT dose (p = 0.0017) were significant factors for survival. However, in multivariate analysis, SBRT dose (p = 0.0072) was the most significant factor, while Child-Pugh stage of borderline significance. (p = 0.0514). Acute toxicities were mild and well tolerated.
  
  
  CONCLUSIONS
  This study showed that SBRT can be delivered safely to huge HCC and achieved a substantial tumor regression and survival. The results suggest this technique should be considered a salvage treatment. However, local and regional recurrence remain the major cause of failure. Further studies of combination of SBRT and other treatment modalities may be reasonable.
authors.affiliation: Department of Radiation Oncology, Chi Mei Medical Center, No,901, Zhonghua Road, Yongkang district, Tainan, Taiwan. jennyque28@yahoo.com.tw.
authors.forename: Jenny Y
authors.initials: JY
authors.lastname: Que
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Lin
authors.forename: Kuei-Li
authors.initials: KL
authors.lastname: Lin
authors.forename: Chia-Hui
authors.initials: CH
authors.lastname: Lin
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Lin
authors.forename: Ching-Chieh
authors.initials: CC
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D016634:Radiosurgery; D015996:Survival Rate; D047368:Tumor Burden