M. Tanious1, J. Robbins1, N. Berger1, A. Hammad1, R. Rajeev1, K. K. Turaga1, F. M. Johnston1, S. Tsai1, K. K. Christians1, T. Gamblin1 1Medical College Of Wisconsin,Milwaukee, WI, USA
Introduction: External radiation therapy (XRT) for hepatocellular carcinoma (HCC) has been limited due to potential radiation induced liver disease (RILD). Interest in XRT has recently grown due to the ability to deliver focused high doses of XRT. We aimed to evaluate and synthesize the recent published data regarding HCC and stereotactic body radiotherapy (SBRT).
Methods: A systematic literature search using a predefined protocol was utilized to identify publications of XRT and HCC in PubMed, Ovid Medline, Scopus, Web of Science (WOS), and Cochrane Library (2000-2015). Primary outcomes of interest were overall survival (OS) and toxicity associated with SBRT.
Results: From a pool of 5,064 articles, 10 involving SBRT were retained for data extraction consisting of 5 retrospective cohort studies, 4 prospective observational studies and 1 prospective phase 2 trial. A total of 565 patients were identified of which 404 were male (72%). Median OS range was 11-41 months, while 1-, 2- and 3- year OS rates ranged from 50-95%, 43-83%, and 23-70%, respectively. Objective tumor response rates of 63-86% and progression of disease at follow-up was documented in 0-8% of cases. Grade 3/4 toxicities due to SBRT were observed in 0-26%, and RILD was observed in 11 patients (2%) with 3 deaths from liver failure.
Conclusion: SBRT for HCC lesions may offer an effective therapy in selective cases. With encouraging OS outcomes and infrequent reported hepatic toxicity, XRT represents a potential treatment for inoperable patients.