Outcomes of Hepatocellular Carcinoma Treated with Liver SBRT

Purpose: While transplant is the only curative treatment for patients with hepatocellular carcinoma (HCC), patients who are not suitable candidates for transplant often receive local therapies to the liver. Destination therapy includes transarterial chemoembolization (TACE), radiofrequency ablation (RFA), microwave ablation (MWA), and stereotactic body radiation therapy (SBRT). These treatments can be used as a single modality, or in combination. We evaluated overall survival (OS), progression free survival (PFS) and local recurrence for patients treated with liver SBRT.

Methodology: We identified 152 patients with HCC that were treated with liver SBRT at our institution between November 2005 and September 2020. SBRT was administered as 14-54Gy in 1-5fx. Child -Pugh (CP) status, use of other local therapies (TACE, microwave ablation, RFA, surgery), and site of first progression were recorded. Local and distant recurrence was evaluated on follow-up MRI or CT images. Kaplan-Meier analyses with log-rank tests were performed to evaluate OS and PFS.

Results: Of the 152 patients who underwent liver SBRT as part of HCC treatment, 130 patients (85.5%) had prior liver-directed (surgery, TACE, RFA or MWA) prior to SBRT, while 22 patients had SBRT alone. 12 patients had a liver transplant after SBRT. At the time of data collection, 45 patients (29.6%) had recurred. Seven patients (4.6%) had the treated lesion as the first site of progression, while 33 patients (21.2%) progressed elsewhere in the liver, and 4 patients (2.6%) progressed at distant sites. Median OS was 26.6 months, and median PFS was 16.3 months for the entire cohort. A significant difference in PFS and OS was seen between CP A patients (46.7 months OS, 21.2 months PFS) when compared to CP B/C patients (10.49 months OS, 10.49 months PFS) p< 0.001. In patients treated with combined modality (SBRT plus: TACE, MWA or surgery), median PFS and OS were higher than for patients treated with SBRT alone (PFS 17.8 months vs 9.3 months p< 0.006 and OS 27.7 months vs 19.7 months, p< 0.015). Of note, 12 patients underwent liver transplant following destination therapy, for which median survival was not reached.

Conclusions: In the setting of HCC, SBRT offers a high rate of local control. Patients treated with SBRT in addition to other destination therapies had increased progression free survival and overall survival. In this cohort, liver transplant was curative, as the median survival was not reached for those 12 patients.

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