Safety and Efficacy of Accelerated Hypofractionation and Stereotactic Body Radiotherapy for Hepatocellular Carcinoma Patients with Varying Degrees of Hepatic Impairment
Menée à partir de données portant sur 146 patients atteints d'un carcinome hépatocellulaire et présentant différents degrés d'insuffisance hépatique (durée médiane de suivi : 23 mois), cette étude évalue l'efficacité, du point de vue du contrôle local de la maladie, et la toxicité hépatique d'une radiothérapie corporelle stéréotaxique par rapport à une radiothérapie hypofractionnée accélérée
Purpose/Objectives : To report toxicities and outcomes for stereotactic body radiotherapy (SBRT) and accelerated hypofractionated radiotherapy (AHRT) in patients with Child-Pugh (CP) A/B/C and Albumin-Bilirubin (ALBI) score 1/2/3 hepatocellular carcinoma (HCC). Materials/Methods : We retrospectively reviewed 146 patients with HCC treated with SBRT (50 Gy in 5 fractions) or AHRT (45 Gy in 18 fractions).. The primary endpoint was liver toxicity, defined as an increase in CP score of 2 or more within 6 months of radiotherapy. Secondary endpoints of ALBI change, overall survival and local control were calculated. Results : Median follow-up was 23 months (1 – 59 months). Most received SBRT (72%), while 28% received AHRT.. Of all 146 patients, 45 (31%) had a CP score elevation of 2 or more within 6 months of RT (27 patients (28%) with baseline CP-A/B7 and 18 patients (35%) with baseline CP-B8/B9/C cirrhosis, p=0.45). On multivariate analysis, neither baseline CP nor ALBI score was predictive of toxicity.. No patient with decline in liver functionality of CP ≥ 2 within 6 months of RT returned to baseline at later time points. Eleven grade 4 toxicities were observed. Mean change in raw ALBI score at approximately 6 months was similar for all baseline ALBI groups.. Twenty-two patients received orthotopic liver transplantation following RT, 13 of which had baseline CP-B8/B9/C liver functionality.. For all patients, 1- and 2-year treated-lesion local control (LC) was greater for SBRT as compared to AHRT (2-year LC 94% vs. 65%, p<0.0001). Conclusions : Tolerability of SBRT or AHRT as measured by CP score decline ≥ 2 within 6 months of RT was similar across baseline liver functionality groups. Compared to AHRT, SBRT was associated with superior local control.. As the true tolerability of limited-volume RT for patients with CP-B or -C cirrhosis is unknown, prospective trials validating its safety and efficacy are warranted.