Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

Journal article

PURPOSE: To report outcomes of a phase I study of individualized stereotactic body radiotherapy treatment (SBRT) for unresectable hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC). PATIENTS AND METHODS: Patients with unresectable HCC or IHC, and who are not suitable for standard therapies, were eligible for six-fraction SBRT during 2 weeks. Radiation dose was dependent on the volume of liver irradiated and the estimated risk of liver toxicity based on a normal tissue complication model. Toxicity risk was escalated from 5% to 10% and 20%, within three liver volume-irradiated strata, provided at least three patients were without toxicity at 3 months after SBRT. RESULTS: Forty-one patients with unresectable Child-Pugh A HCC (n = 31) or IHC (n = 10) completed six-fraction SBRT. Five patients (12%) had grade 3 liver enzymes at baseline. The median tumor size was 173 mL (9 to 1,913 mL). The median dose was 36.0 Gy (24.0 to 54.0 Gy). No radiation-induced liver disease or treatment-related grade 4/5 toxicity was seen within 3 months after SBRT. Grade 3 liver enzymes were seen in five patients (12%). Two patients (5%) with IHC developed transient biliary obstruction after the first few fractions. Seven patients (five HCC, two IHC) had decline in liver function from Child-Pugh class A to B within 3 months after SBRT. Median survival of HCC and IHC patients was 11.7 months (95% CI, 9.2 to 21.6 months) and 15.0 months (95% CI, 6.5 to 29.0 months), respectively. CONCLUSION: Individualized six-fraction SBRT is a safe treatment for unresectable HCC and IHC.

Authors: Tse, R; Hawkins, M; Lockwood, G; Kim, J; Cummings, B

• Publication status: Published
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology
• Volume: 26
• Issue: 4
• Pages: 657-664
• Publication date: 2008-02-01
• DOI: 10.1200/jco.2007.14.3529
• EISSN: 1527-7755
• ISSN: 0732-183X
• Language: English
• Keywords: Cholangiocarcinoma; Radiation Injuries; Treatment Outcome; Gastrointestinal Hemorrhage; Adult; Survival Rate; Liver Neoplasms; Female; Humans; Radiotherapy Dosage; Radiosurgery; Aged; Middle Aged; Carcinoma, Hepatocellular; Aged, 80 and over; Male; Intestinal Obstruction