Multicenter results of stereotactic body radiotherapy (SBRT) for non-resectable primary liver tumors

Figures & data

Table I. Demographics and baseline tumor characteristics of patients with non-resectable primary liver tumors treated with SBRT.

	HCC		ICC
	Current series	Literature ^†	Current series	Literature ^† ^†
Number of patients	21	224	11	16
Age (years)
Median (range)	72 (47 – 88)	(23 – 90)	66 (43 – 86)	(49 – 79)
Gender
Male:Female	3.2:1	2.7:1	1.2:1	2:1
MELD score	12 (7 – 21)	-	-	-
Child-Pugh score	6 (5 – 8)	-	-	-
Institution (No of patients)
UHCMC/CC	13	-	5	-
MSK	3	-	5	-
URMC	5	-	1	-
Prior therapy (%)
Resection	9.5	8.7	50	9.1
RFA	4.8	11.3	27.3	0
TACE	14.3	58.6	0	0
Chemotherapy	47.6	7.3	45.5	45.5
Radiation	0	0	0	0
Tumor characteristics
GTV (cm ^3 )
median (range)	334.2 (9.5 – 1493.8)	(3 – 1913)	80.2 (30.6 – 818.5)	(10 – 465)
Number of lesions (%)
1 lesion	76.2	79.8	81.8	100
>1 lesion	23.8	19.4	18.2	0
Metastatic (%)	9.5	2.7	45.5	83.3
SBRT
Total dose (Gy)
median (range)	30 (18 – 50)	(14 – 60)	30 (22 – 50)	(28.2 – 65)
Number of fractions	(1 – 10)	(1 – 12)	(1 – 10)	(3 – 6)
EQD2
median (range)	50 (30 – 94)	-	70 (33 – 100)	-
Isodose line (%)
median (range)	70 (60 – 75)	(65 – 95)	70 (65 – 70)	(65 – 80)

CC, Cleveland Clinic; GTV, gross tumor volume; Gy, grey; HCC, hepatocellular carcinoma; ICC intrahepatic cholangiocarcinoma; MSK, Memorial Sloan-Kettering; RFA, radiofrequency ablation; SBRT, stereotactic body radiotherapy; TACE, transarterial chemoembolization; UHCMC, University Hospitals-Case Medical Center; URMC, University of Rochester Medical Center.

^†references [13,17,22,23,26–28,30,31,34]; ^††references [13,15,17,29,34]

Figure 1. Overall freedom from local progression (FFLP) in patients with primary liver tumors from the time of SBRT treatment. The median time to local progression for patients with HCC was 6.3 months (range: 3.2–14.8 months). FFLP rates at 6-months and 1-year were 83 and 64%. The median time to local progression for patients with ICC was 4.3 months (range: 3.1–6.4 months). FFLP rates at 6-months and 1-year were 63 and 50%.

Figure 2. Overall survival (OS) of patient with primary liver tumors from the time of SBRT treatment. The median OS for patient with HCC was 34 months. The estimated 1-year and 2-years survival rates were 87 and 55%, respectively. The median OS for patients with ICC was 11 months. The estimated 6-months and 1-year survival rates were 75 and 45%, respectively.

Table

Number of patients at risk:
Time (months)	0	6	12	18	24
HCC	19	14	9	6	2
ICC	9	5	2	0	0

Figure 3. Box plot of tumor gross tumor volume (GTV) response in patients with non-resectable HCC treated with SBRT. GTV decreased from an initial median of 334.2 cm³ to a final median of 135 cm³ at 3 months follow-up (p = 0.002, two-sided paired t-test), follow-up data available for 19 patients in our series.

Table

Number of patients at risk:
Time (months)	0	6	12	18	24
HCC	22	17	11	9	3
ICC	11	5	1	0	0

Table II. Survival data, tumor response and recurrence of malignancy of patients with non-resectable primary liver tumors treated with SBRT.

	HCC		ICC
	Current series	Literature^†	Current series	Literature^††
Number of patients	21	224	11	16
Median FU (range, months)	12.9 (0.5–54)	(1–54)	4.8 (1.4–17.9)	(8–48)
Median overall survival (months)	34	(11.7–32)	11	(8–48)
1 year survival (%)	87	71	45	58
2 year survival (%)	55	48	-	-
3 year survival (%)	27	44	-	-
Overall freedom from local progression (%)	63.2	74	55.5	100
Median time to local progression (range)	6.3 (3.2–14.8)	-	4.2 (2.1–6.4)	-
RECIST (%,*)
CR	10.5	34.9	11.1	-
PR	15.8	18.1	22.2	–
PD	42.1	41.2	44.4	-
Partial tumor response grade (%,**)
Grade 1	25	-	25	-
Grade 2	16.7	–	25	–
Grade 3	58.3	–	0	–
Tumor recurrence (%,***)
Grade 1a	10.5	7.7	22.2	-
Grade 1b	21.1	16.5	11.1	–
Grade 2	0	10.3	11.1	-
Grade 3	0	12.9	0	-
Grade 4	10.5	14.3	22.2	-
Overall	42.1	61.7	66.7	-

CR, complete response; FU, follow-up; HCC, hepatocellular carcinoma; ICC intrahepatic cholangiocarcinoma; PD, progressive disease;

PR, partial response; SBRT, stereotactic body radiotherapy; SD, stable disease.

*Follow-up imaging data for RECIST was available only for 19 HCC and 9 ICC patients in our series and 92 HCC patients in the literature.

**Follow-up tumor volumes were available only for 12 HCC and 4 ICC patients in our series.

***Tumor recurrence data only available from 116 HCC patients in the literature.

^†references [13,17,22,23,26–28,30,31,34].

^††references [13,15,17,29,34].

Table III. Radiation induced adverse events* reported in patients with non-resectable primary liver tumors treated with SBRT.

	HCC		ICC
	Current series	Literature^†	Current series	Literature^††
Number of patients	21	224	11	16
Adverse events (%)
Grade 1	25	32	28	33
Grade 2	5	26	21	33
Grade 3	4	10	7	17
Grade 4	4	2	0	0
Grade 5	0	0.4	0	0

HCC, hepatocellular carcinoma; ICC intrahepatic cholangiocarcinoma; SBRT, stereotactic body radiotherapy.

*National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v3.0).

†references [13,17,22,23,26–28,30,31,34] data available for 173 patients.

††references [13,15,17,29,34] events data available for 12 patients.

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