title: Repeated stereotactic ablative radiotherapy using CyberKnife for patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  This study aimed to evaluate the outcomes and toxicities of repeated stereotactic ablative radiotherapy (SABR) in hepatocellular carcinoma (HCC).
  
  
  METHODS
  Fourteen HCC patients with local recurrence (18 lesions) after liver SABR received repeated radiotherapy with SABR using CyberKnife. No patients experienced radiation-induced liver disease after the first SABR course. The median first SABR dose was 41 Gy (range, 34-60 Gy); the median second SABR dose, 40 Gy (range, 25-50 Gy); and the median interval, 12.9 months. Local recurrence was divided into in-field recurrence and out-field recurrence.
  
  
  RESULTS
  Objective responses were observed in 11 tumors (61.1%), including five tumors (27.8%) with complete responses. Intrahepatic out-field failure was the main cause of treatment failure (7 of 14 patients). In-field failure had developed in 1 of 18 tumors (5.6%), resulting in a 2-year in-field failure-free rate of 88.2%. The median time to progression was 14.0 months, with 1- and 2-year progression-free survival rates of 68.6% and 42.9%, respectively. One- and two-year overall survival rates were 76% and 59.1%, respectively. Of the 14 patients, one developed radiation-induced liver disease and three showed progression of the Child-Turcotte-Pugh class after the second SABR course. Other toxicities were generally mild and tolerable.
  
  
  CONCLUSIONS
  Repeated SABR in selected HCC patients is feasible with acceptable toxicity.
authors.affiliation: Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Cheng-Hsiang
authors.initials: CH
authors.lastname: Lo
authors.forename: Wen-Yen
authors.initials: WY
authors.lastname: Huang
authors.forename: Kuen-Tze
authors.initials: KT
authors.lastname: Lin
authors.forename: Miao-Jung
authors.initials: MJ
authors.lastname: Lin
authors.forename: Te-Pao
authors.initials: TP
authors.lastname: Lin
authors.forename: Yee-Min
authors.initials: YM
authors.lastname: Jen
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality; D011879:Radiotherapy Dosage; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome
keywords: CyberKnife; hepatocellular carcinoma; repeated radiotherapy; stereotactic ablative radiotherapy