title: Stereotactic ablative radiotherapy in the treatment of hepatocellular carcinoma >3 cm.
abstract: Stereotactic ablative radiotherapy (SABR) is a safe treatment approach for hepatocellular carcinoma (HCC) with comparable results to other local therapies. For lesions larger than 3 cm, no definitive standard treatment is present and several options are available. We retrospectively review local control (LC) and survival results of SABR in patients with HCC lesions >3 cm. Between 2012 and 2015, we treated 29 patients (39 lesions) having histological or radiological diagnosis of HCC and at least one lesion sized >3 cm. Patients were prescribed 36-48 Gy in 3-5 fractions (mainly 16 Gy × 3 fractions or 8 Gy × 5 fractions), in 3-5 consecutive days. A total of 15 lesions (52 %) had complete, while 10 (34 %) had partial remission; 3 (11 %) had a stable disease. Mean time for CR achievement was 5.8 months (range 1-17). One- and two-year actuarial LC was 100 %. Moreover, 1- and 2-year progression-free (PFS), cancer-specific and overall survival were 57.9 % [standard error (SE) 0.09; 95 % CI 36.9-74.2] and 41.2 % (SE 0.12; 95 % CI 17.7-63.5), 80.7 % (SE 0.08; 95 % CI 59.6-91.5) and 63.3 % (SE 0.11; 95 % CI 38.4-80.3), 71.7 % (SE 0.08; 95 % CI 51.2-84.7) and 56.2 % (SE 0.10; 95 % CI 33.8-73.6). On multivariate analysis, achieving a CR within the target lesion had a borderline significance with respect to PFS (HR 0.83; SE = 0.014; z -1.15; p = 0.095; 95 % CI 0.71-7.45). Time between HCC diagnosis and SABR delivery (< vs >12 months) was significantly correlated with OS (HR 16.5; SE 21.5; z = 2.14; p = 0.032; 95 % CI 1.27-213.3) as CLIP score (score: 0-1 vs 2) (HR 5.6; SE 4.6; z = 2.10; p = 0.036; 95 % CI 1.11-27.8). A total of 6 major toxic events (G3-G4) were recorded (20 %). In 2 patients (6 %), a radiation-induced liver disease was seen. In conclusion, SABR provided LC and survival rates comparable to other local therapies for patients with HCC lesion sized >3 cm, with acceptable toxicity profile.
authors: Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy.
authors: Alessia
authors: A
authors: Guarneri
authors: Department of Oncology, Radiation Oncology, School of Medicine, University of Turin, Via Genova 3, 10126, Turin, Italy. pierfrancesco.franco@unito.it.
authors: Pierfrancesco
authors: P
authors: Franco
authors: Department of Oncology, Radiation Oncology, School of Medicine, University of Turin, Via Genova 3, 10126, Turin, Italy.
authors: Elisabetta
authors: E
authors: Trino
authors: Gastro-Hepatology Unit, Department of Medical Sciences, University of Torino, Turin, Italy.
authors: Daniela
authors: D
authors: Campion
authors: Radiology Unit, Department of Surgical Sciences, University of Torino, Turin, Italy.
authors: Riccardo
authors: R
authors: Faletti
authors: Department of Surgical Sciences, Liver Transplantation Center, University of Turin, Turin, Italy.
authors: Stefano
authors: S
authors: Mirabella
authors: Gastro-Hepatology Unit, Department of Medicine, AOU Città della Salute e della Scienza, Turin, Italy.
authors: Silvia
authors: S
authors: Gaia
authors: Department of Oncology, Radiation Oncology, School of Medicine, University of Turin, Via Genova 3, 10126, Turin, Italy.
authors: Riccardo
authors: R
authors: Ragona
authors: Gastro-Hepatology Unit, Department of Medical Sciences, University of Torino, Turin, Italy.
authors: Margherita
authors: M
authors: Diotallevi
authors: Gastro-Hepatology Unit, Department of Medical Sciences, University of Torino, Turin, Italy.
authors: Giorgio
authors: G
authors: Saracco
authors: Department of Surgical Sciences, Liver Transplantation Center, University of Turin, Turin, Italy.
authors: Mauro
authors: M
authors: Salizzoni
authors: Department of Oncology, Radiation Oncology, School of Medicine, University of Turin, Via Genova 3, 10126, Turin, Italy.
authors: Umberto
authors: U
authors: Ricardi
authors: Gastro-Hepatology Unit, Department of Medicine, AOU Città della Salute e della Scienza, Turin, Italy.
authors: Patrizia
authors: P
authors: Carucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Hepatocellular carcinoma; Microwave; Radiation; Radiofrequency ablation; Stereotactic ablative radiotherapy; TACE