Safety and Efficacy of Accelerated Hypofractionation and Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma Patients With Varying Degrees of Hepatic Impairment

Nima Nabavizadeh, Joseph G. Waller, Robert Fain, Yiyi Chen, Catherine R. Degnin, David A. Elliott, Brandon T. Mullins, Ishan A. Patel, Brandon A. Dyer, Kareem Fakhoury, Willscott (Scott) Naugler, Khashayar Farsad, James Tanyi, Martin Fuss, Charles Thomas, Arthur Hung

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Abstract

Purpose: To report the toxicities and outcomes for stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy (AHRT) in patients with Child-Pugh (CP) class A, B, or C and albumin-bilirubin (ALBI) score 1, 2, or 3 hepatocellular carcinoma. Methods and Materials: We retrospectively reviewed the data from 146 patients with hepatocellular carcinoma who had undergone SBRT (50 Gy in 5 fractions) or AHRT (45 Gy in 18 fractions). The primary endpoint was liver toxicity, defined as an increase in the CP score of ≥2 within 6 months of radiation therapy. The secondary endpoints of ALBI change, overall survival, and local control were also calculated. Results: The median follow-up was 23 months (range 1-59). Most received SBRT (72%), and 28% received AHRT. Of all 146 patients, 45 (31%) had a CP score elevation of ≥2 within 6 months of radiation therapy (RT) (27 patients [28%] with baseline CP-A/B7 and 18 [35%] with baseline CP-B8/B9/C cirrhosis; P =.45). On multivariate analysis, neither baseline CP nor ALBI score was predictive of toxicity. No patient with a 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. The mean change in the raw ALBI score at ∼6 months was similar for all baseline ALBI groups. Twenty-two patients underwent orthotopic liver transplantation after RT, 13 of whom had baseline CP-B8/B9/C liver functionality. For all patients, the 1- and 2-year treated-lesion local control was greater for SBRT than for AHRT (2-year 94% vs 65%, P <.0001). Conclusions: The tolerability of SBRT or AHRT as measured by a CP score decline of ≥2 within 6 months of RT was similar across baseline liver functionality groups. Compared with AHRT, SBRT was associated with superior local control. Because the true tolerability of limited-volume RT for patients with CP-B or CP-C cirrhosis is unknown, prospective trials validating its safety and efficacy are warranted.

Original languageEnglish (US)
Pages (from-to)577-585
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume100
Issue number3
DOIs
StatePublished - Mar 1 2018

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impairment
Hepatocellular Carcinoma
radiation therapy
safety
Radiotherapy
cancer
Safety
Liver
albumins
Bilirubin
liver
Albumins
toxicity
Fibrosis
transplantation

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Safety and Efficacy of Accelerated Hypofractionation and Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma Patients With Varying Degrees of Hepatic Impairment. / Nabavizadeh, Nima; Waller, Joseph G.; Fain, Robert; Chen, Yiyi; Degnin, Catherine R.; Elliott, David A.; Mullins, Brandon T.; Patel, Ishan A.; Dyer, Brandon A.; Fakhoury, Kareem; Naugler, Willscott (Scott); Farsad, Khashayar; Tanyi, James; Fuss, Martin; Thomas, Charles; Hung, Arthur.

In: International Journal of Radiation Oncology Biology Physics, Vol. 100, No. 3, 01.03.2018, p. 577-585.

Research output: Contribution to journalArticle

Nabavizadeh, Nima ; Waller, Joseph G. ; Fain, Robert ; Chen, Yiyi ; Degnin, Catherine R. ; Elliott, David A. ; Mullins, Brandon T. ; Patel, Ishan A. ; Dyer, Brandon A. ; Fakhoury, Kareem ; Naugler, Willscott (Scott) ; Farsad, Khashayar ; Tanyi, James ; Fuss, Martin ; Thomas, Charles ; Hung, Arthur. / Safety and Efficacy of Accelerated Hypofractionation and Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma Patients With Varying Degrees of Hepatic Impairment. In: International Journal of Radiation Oncology Biology Physics. 2018 ; Vol. 100, No. 3. pp. 577-585.
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abstract = "Purpose: To report the toxicities and outcomes for stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy (AHRT) in patients with Child-Pugh (CP) class A, B, or C and albumin-bilirubin (ALBI) score 1, 2, or 3 hepatocellular carcinoma. Methods and Materials: We retrospectively reviewed the data from 146 patients with hepatocellular carcinoma who had undergone SBRT (50 Gy in 5 fractions) or AHRT (45 Gy in 18 fractions). The primary endpoint was liver toxicity, defined as an increase in the CP score of ≥2 within 6 months of radiation therapy. The secondary endpoints of ALBI change, overall survival, and local control were also calculated. Results: The median follow-up was 23 months (range 1-59). Most received SBRT (72{\%}), and 28{\%} received AHRT. Of all 146 patients, 45 (31{\%}) had a CP score elevation of ≥2 within 6 months of radiation therapy (RT) (27 patients [28{\%}] with baseline CP-A/B7 and 18 [35{\%}] with baseline CP-B8/B9/C cirrhosis; P =.45). On multivariate analysis, neither baseline CP nor ALBI score was predictive of toxicity. No patient with a 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. The mean change in the raw ALBI score at ∼6 months was similar for all baseline ALBI groups. Twenty-two patients underwent orthotopic liver transplantation after RT, 13 of whom had baseline CP-B8/B9/C liver functionality. For all patients, the 1- and 2-year treated-lesion local control was greater for SBRT than for AHRT (2-year 94{\%} vs 65{\%}, P <.0001). Conclusions: The tolerability of SBRT or AHRT as measured by a CP score decline of ≥2 within 6 months of RT was similar across baseline liver functionality groups. Compared with AHRT, SBRT was associated with superior local control. Because the true tolerability of limited-volume RT for patients with CP-B or CP-C cirrhosis is unknown, prospective trials validating its safety and efficacy are warranted.",
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AU - Nabavizadeh, Nima

AU - Waller, Joseph G.

AU - Fain, Robert

AU - Chen, Yiyi

AU - Degnin, Catherine R.

AU - Elliott, David A.

AU - Mullins, Brandon T.

AU - Patel, Ishan A.

AU - Dyer, Brandon A.

AU - Fakhoury, Kareem

AU - Naugler, Willscott (Scott)

AU - Farsad, Khashayar

AU - Tanyi, James

AU - Fuss, Martin

AU - Thomas, Charles

AU - Hung, Arthur

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N2 - Purpose: To report the toxicities and outcomes for stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy (AHRT) in patients with Child-Pugh (CP) class A, B, or C and albumin-bilirubin (ALBI) score 1, 2, or 3 hepatocellular carcinoma. Methods and Materials: We retrospectively reviewed the data from 146 patients with hepatocellular carcinoma who had undergone SBRT (50 Gy in 5 fractions) or AHRT (45 Gy in 18 fractions). The primary endpoint was liver toxicity, defined as an increase in the CP score of ≥2 within 6 months of radiation therapy. The secondary endpoints of ALBI change, overall survival, and local control were also calculated. Results: The median follow-up was 23 months (range 1-59). Most received SBRT (72%), and 28% received AHRT. Of all 146 patients, 45 (31%) had a CP score elevation of ≥2 within 6 months of radiation therapy (RT) (27 patients [28%] with baseline CP-A/B7 and 18 [35%] with baseline CP-B8/B9/C cirrhosis; P =.45). On multivariate analysis, neither baseline CP nor ALBI score was predictive of toxicity. No patient with a 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. The mean change in the raw ALBI score at ∼6 months was similar for all baseline ALBI groups. Twenty-two patients underwent orthotopic liver transplantation after RT, 13 of whom had baseline CP-B8/B9/C liver functionality. For all patients, the 1- and 2-year treated-lesion local control was greater for SBRT than for AHRT (2-year 94% vs 65%, P <.0001). Conclusions: The tolerability of SBRT or AHRT as measured by a CP score decline of ≥2 within 6 months of RT was similar across baseline liver functionality groups. Compared with AHRT, SBRT was associated with superior local control. Because the true tolerability of limited-volume RT for patients with CP-B or CP-C cirrhosis is unknown, prospective trials validating its safety and efficacy are warranted.

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