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Abstract Details
Individualized adaptive radiation therapy allows for safe treatment of hepatocellular carcinoma in patients with Child-Turcotte-Pugh B liver disease
Int J Radiat Oncol Biol Phys. 2020 Aug 24;S0360-3016(20)34141-9.doi: 10.1016/j.ijrobp.2020.08.046. Online ahead of print.
William C Jackson1, Ming Tang2, Christopher Maurino2, Mishal Mendiratta-Lala3, Neehar D Parikh4, Martha M Matuszak2, Janell S Dow2, Yue Cao2, Charles S Mayo2, Randall K Ten Haken2, Matthew J Schipper2, Kyle C Cuneo2, Dawn Owen2, Theodore S Lawrence2
Author information
1University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan. Electronic address: wcj@med.umich.edu.
2University of Michigan Department of Radiation Oncology, Ann Arbor, Michigan.
3University of Michigan Department of Radiology, Ann Arbor, Michigan.
4University of Michigan Department of Gastroenterology, Ann Arbor, Michigan.
Abstract
Purpose: Previous reports of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) suggest unacceptably high rates of toxicity in patients with Child-Turcotte-Pugh B (CTP-B) liver disease. We hypothesized that an individualized adaptive treatment approach based on mid-treatment liver function would maintain good local control while limiting toxicity in this population.
Methods and materials: Patients with CTP-B liver disease and HCC were treated on prospective trials of individualized adaptive SBRT from 2006-2018. Patients underwent pre and mid-treatment liver function assessment using indocyanine green. Treatment related toxicity was defined as a ≥2-point rise in CTP score from pre-treatment within 6 months of treatment. In addition, we performed analyses with a longitudinal model assessing changes in CTP score over 12 months post-SBRT.
Results: Eighty CTP-B patients (median tumor size 2.5 cm) were treated. 37 patients were CTP-B-7, 28 CTP-B-8, and 15 CTP-B-9. Median treatment dose was 36 Gy in 3 fractions. One-year local control was 92%. In a multivariate model controlling for tumor size, treatment dose, and baseline CTP score, higher treatment dose was associated with improved freedom from local progression (HR:0.97, 95% CI:0.94-1.00, p=0.04). Eighteen patients (24%) had a ≥2-point rise in CTP score within 6 months of SBRT. In a longitudinal model assessing changes in CTP score over 12 months post-SBRT, controlling for baseline CTP and tumor size, increasing MLD was associated with larger increases in CTP score (p=0.04).
Conclusion: An individualized adaptive treatment approach allows for acceptable toxicity and effective local control in patients with HCC and CTP-B liver disease. As increasing dose may increase both local control and toxicity, further work is needed to optimize treatment in patients with compromised liver function.