Biochemical Safety of SBRT to Multiple Intrahepatic Lesions for Hepatocellular Carcinoma

Abstract

Background

We aim to better characterize stereotactic body radiation therapy (SBRT)-related hepatic biochemical toxicity in patients with multiple intrahepatic lesions from hepatocellular carcinoma (HCC).

Methods

We conducted a retrospective analysis of patients with HCC who underwent SBRT for 2 or more synchronous or metachronous liver lesions. We collected patient characteristics and dosimetric data (mean liver dose [MLD], cumulative effective volume [Veff], cumulative volume of liver receiving 15 Gy [V15Gy], and cumulative planning target volume [PTV]) along with liver-related toxicity (measured by albumin-bilirubin [ALBI] and Child–Pugh [CP] scores). A linear mixed-effects model was used to assess the effect of multi-target SBRT on changes in ALBI.

Results

There were 25 patients and 56 lesions with median follow-up of 29 months. Eleven patients had synchronous lesions, and 14 had recurrent lesions treated with separate SBRT courses. Among those receiving multiple SBRT courses, there were 7 lesions with overlap of V15Gy (median V15Gy overlap: 35 mL, range: 0.5–388 mL). There was no association between cumulative MLD, Veff, V15Gy, or PTV and change in ALBI. Four of 25 patients experienced non-classic radiation-induced liver disease (RILD), due to an increase of CP score by ≥2 points 3 to 6 months after SBRT. Sixteen of 25 patients experienced an increase in ALBI grade by 1 or more points 3 to 6 months after SBRT. Comparing the groups that received SBRT in a single course versus multiple courses revealed no statistically significant differences in liver toxicity.

Conclusion

Liver SBRT for multiple lesions in a single or in separate courses is feasible and with acceptable risk of hepatotoxicity. Prospective studies with a larger cohort are needed to better characterize safety in this population.

Keywords:

• HCC
• SBRT
• reirradiation
• multi-site
• toxicity

Abbreviations

ALBI, albumin-bilirubin; BSA, body surface area; CP, Child–Pugh; CT, computed tomography; Veff, effective volume, Gy, gray; HCC, hepatocellular carcinoma; LC, local control; MRI, magnetic resonance imaging; MLD, mean liver dose; NAFLD, nonalcoholic fatty liver disease; NTCP, normal tissue complication probability; OARs, organs at risk; OS, overall survival; PTV, planning target volume; pFLV, predicted functional liver volume; RILD, radiation-induced liver disease, SBRT, stereotactic body radiation therapy; RFA, radiofrequency ablation; TACE, transarterial chemoembolization; n, volume effect; V15Gy, volume of liver receiving 15 Gy.

Acknowledgments

This study was presented at the American Society of Clinical Oncology Gastrointestinal Cancers Symposium, San Francisco, January 18, 2024.

Disclosure

AMM reports grants or contracts from the American Association for the Study of Liver Diseases, the American College of Gastroenterology, and the National Institutes of Health; and consulting fees from Target RWE; and serves on the American Association for the Study of Liver Diseases Practice Guidelines Committee. TKY reports grants or contracts from the Radiation Oncology Institute and Lineberger Comprehensive Cancer Center. The authors report no other conflicts of interest in this work.

Additional information

Funding

There is no funding to report.