PMID- 29553972
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201106
IS  - 1537-453X (Electronic)
IS  - 0277-3732 (Linking)
VI  - 41
IP  - 11
DP  - 2018 Nov
TI  - Stereotactic Body Radiation Therapy (SBRT) for Hepatocellular Carcinoma: High 
      Rates of Local Control With Low Toxicity.
PG  - 1118-1124
LID - 10.1097/COC.0000000000000435 [doi]
AB  - OBJECTIVES: Stereotactic body radiotherapy (SBRT) is potentially curative 
      treatment for small hepatocellular carcinomas (HCC), but data are limited on its 
      efficacy and toxicity. We hypothesized that SBRT can achieve excellent local 
      control (LC) with acceptable toxicity treating HCC lesions, even in advanced 
      cirrhosis. MATERIALS AND METHODS: Thirty-seven nonmetastatic HCC patients 
      received SBRT to 43 lesions between October 2012 and April 2016. Median dose was 
      50 Gy/5 fractions. All Child-Pugh (CP) >/=B patients underwent a planned 1-month 
      break after the first 3 fractions to assess hepatic toxicity. Patients were 
      treated without separately placed fiducial markers using Linac-based SBRT with 
      breath-hold (67%) or 4D-computed tomography with compression belt (33%) to reduce 
      motion. Patients underwent magnetic resonance imaging q3 months post-SBRT. 
      RESULTS: Median age was 65 (range, 44 to 88). Pre-SBRT mean CP was 6.4 (range, A5 
      to C11). Nine (24%) had CP>/=B8. Thirty-one of 33 patients (93%) had prior 
      liver-directed therapy (median 2). Seventeen (40%) had solitary lesions. Median 
      lesion diameter was 2.7 cm (range, 1.1 to 5.6). Median follow-up was 14 months 
      (range, 2 to 45). There was 1 local failure (multifocal HCC with 3 prior 
      transarterial chemoembolization). LC, freedom from liver progression, and overall 
      survival at 12 months was 95%, 66%, 87% in the full cohort, and 100%, 76%, 93% 
      for patients with solitary lesions. Four had grade 3 toxicity (ascites 
      [n=2]/gastrointestinal bleed [n=1]/capsular pain [n=1]). Eight of 9 CP>/=B8 
      patients had no grade >/=3 hepatic toxicity. CONCLUSIONS: SBRT for HCC is 
      well-tolerated even in patients with advanced cirrhosis and prior liver-directed 
      treatment and provides excellent LC even for larger lesions that cannot be 
      controlled with radiofrequency ablation. LC with SBRT compares favorably to other 
      liver-directed therapies. Prospective studies comparing SBRT with other 
      liver-directed therapies are warranted.
FAU - Baumann, Brian C
AU  - Baumann BC
AD  - Departments of *Radiation Oncology  parallelMedical Oncology #Transplant Surgery 
      **Interventional Radiology daggerdaggerRadiology daggerLeonard Davis Institute of Health 
      Economics  section signPerelman School of Medicine  paragraph signDivision of Gastroenterology and 
      Hepatology, University of Pennsylvania, Philadelphia, PA double daggerDepartment of Radiation 
      Oncology, Siteman Cancer Center, Washington University in Saint Louis, Saint 
      Louis, MO.
FAU - Wei, Jenny
AU  - Wei J
FAU - Plastaras, John P
AU  - Plastaras JP
FAU - Lukens, John N
AU  - Lukens JN
FAU - Damjanov, Nevena
AU  - Damjanov N
FAU - Hoteit, Maarouf
AU  - Hoteit M
FAU - Hsu, Christine
AU  - Hsu C
FAU - Levine, Matthew
AU  - Levine M
FAU - Mondschein, Jeffrey
AU  - Mondschein J
FAU - Nadolski, Gregory
AU  - Nadolski G
FAU - Olthoff, Kim
AU  - Olthoff K
FAU - Reiss, Kim A
AU  - Reiss KA
FAU - Rosen, Mark
AU  - Rosen M
FAU - Siegelman, Evan
AU  - Siegelman E
FAU - Metz, James M
AU  - Metz JM
FAU - Ben-Josef, Edgar
AU  - Ben-Josef E
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Clin Oncol
JT  - American journal of clinical oncology
JID - 8207754
SB  - IM
EDAT- 2018/03/20 06:00
MHDA- 2018/03/20 06:01
CRDT- 2018/03/20 06:00
PHST- 2018/03/20 06:00 [pubmed]
PHST- 2018/03/20 06:01 [medline]
PHST- 2018/03/20 06:00 [entrez]
AID - 10.1097/COC.0000000000000435 [doi]
PST - ppublish
SO  - Am J Clin Oncol. 2018 Nov;41(11):1118-1124. doi: 10.1097/COC.0000000000000435.