High-dose stereotactic body radiotherapy correlates increased local control and overall survival in patients with inoperable hepatocellular carcinoma

Radiation Oncology

Young Han Kim⁷  Eung-Ho Cho⁶  Sang Bum Kim⁶  Su Cheol Park⁴  Jin Kim⁴  Chul Ju Han⁴  Dong Han Lee¹  So Young Kim³  Jin-Kyu Kang⁵  Young Seok Seo⁵  Hyung Jun Yoo⁵  Chul Koo Cho⁵  Sun Hyun Bae²  Mi-Sook Kim⁵  Won Il Jang⁵ 

[1] Cyberknife Center, Korea Institute of Radiological & Medical Science, Seoul, Republic of Korea;Department of Radiation Oncology, Kyung Hee University Gangdong Hospital, Seoul, Republic of Korea;Division of Heavy Ion Clinical Research, Korea Institute of Radiological & Medical Science, Seoul, Republic of Korea;Department of Internal Medicine, Korea Institute of Radiological & Medical Science, Seoul, Republic of Korea;Department of Radiation Oncology, Korea Institute of Radiological & Medical Science, Seoul, Republic of Korea;Department of Surgery, Korea Institute of Radiological & Medical Science, Seoul, Republic of Korea;Department of Radiology, Korea Institute of Radiological & Medical Science, Seoul, Republic of Korea

关键词: Dose-survival relationship;    Dose–response relationship;    Stereotactic body radiotherapy;    Radiotherapy;    Hepatocellular carcinoma;   

Others  :  1152655
DOI  :  10.1186/1748-717X-8-250

 received in 2013-06-11, accepted in 2013-10-23,  发布年份 2013

【 摘 要 】

Background

Recent studies using stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) have reported high tumor response and local control. However, the optimal SBRT dose remains unknown, and it is still not clear whether a dose response relationship for local control (LC) and overall survival (OS) exist or not. We performed this study to determine whether a dose response relationship for LC and OS is observed in SBRT for inoperable HCC.

Methods

Between 2003 and 2011, 108 patients with HCC were treated with SBRT. All patients were unsuitable for surgery or local ablation and had incomplete response to transarterial chemoembolization. Eighty-two patients with a longest tumor diameter (LD) less than or equal to 7.0 cm who were treated with 3-fraction SBRT and were analyzed. This cohort comprised 74 Child-Turcotte-Pugh (CTP) class A patients and 8 CTP class B7 patients. The median LD was 3.0 cm (range, 1.0–7.0 cm), and the median dose was 51 Gy (range, 33–60 Gy).

Results

LC and OS rates at 2 years after SBRT were 87% and 63%, respectively, with a median follow-up duration of 30 months for all patients. The 2-year LC/OS rates for patients treated with doses of > 54, 45–54, and < 45 Gy were 100/71, 78/64, and 64%/30%, respectively (p = .009/p < .001). Multivariate analysis revealed that the SBRT dose (p = .005) and Barcelona Clinic Liver Cancer stage (p = .015) were significant prognostic factors for OS. Correlation analysis revealed a positive linear relationship between the SBRT dose and LC (p = .006, R = .899)/OS (p = .002, R = .940) at 2 years. Based on the tumor-control probability model, a dose of 54.8 Gy provides 2-year LC with a 90% probability. Five patients experienced grade 3 or higher gastrointestinal toxicity, and 6 had deteriorating of CTP score by greater than or equal to 2 within 3 months of SBRT.

Conclusions

This study demonstrated a dose response relationship for LC and OS with SBRT for HCC. Higher LC rates resulting from an increased dose may translate into survival benefits for patients with HCC.

【 授权许可】

   
2013 Jang et al.; licensee BioMed Central Ltd.

【 图 表 】

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