Repeated Stereotactic Body Radiation Therapy For Hepatocellular Carcinoma

To determine the feasibility and efficacy of repeated stereotactic body radiation therapy (SBRT) for inoperable hepatocellular carcinoma (HCC). We retrospectively reviewed 28 HCC patients who were treated with the repeated SBRT at Korea Cancer Center Hospital between January 2004 and May 2014. All patients were unsuitable for surgery or local ablation and had incomplete response to transarterial chemoembolization. Twenty-seven patients (96%) underwent the repeated SBRT for intrahepatic recurrence other than the lesion with the 1st SBRT, and only one patient underwent re-irradiation for the same lesion with the 1st SBRT. Twenty-seven patients (96%) had Child-Turcotte-Pugh (CTP) class A (A5 in 23 and A6 in 4, respectively). The median dose was 51 Gy (range, 30-60 Gy in 3–5 fractions) and 44 Gy (range, 30–60 Gy in 3-4 fractions) in the 1st and the repeated SBRT, respectively. The median follow-up duration was 11 months (range, 2–56 months). The median interval between the first and the repeated SBRT was 11 months (range, 2–48 months). The 2-year local failure-free and overall survival rates were 77% and 42%, respectively. Three patients (11%) experienced deteriorating of CTP score by greater than or equal to 2 within 3 months of SBRT without disease progression. The total mean normal liver dose was the most significant predictor for hepatic deterioration after the repeated SBRT. This study showed that the repeated SBRT can be safely and effectively administered to the patients with inoperable HCC, and these results suggest that this technique might be considered a salvage treatment. We suggest that patients with the repeated SBRT should be treated using the total mean normal liver dose constraint of 32 Gy3 or less. A further well-controlled large-scale study and longer follow-up are needed to determine the optimal dose-volume constraints and characterize late complications.