Liang‑Cheng Chena, Hon‑Yi Lina,b,c, Moon‑Sing Leea,b, Wen‑Yen Chioua,b, Li‑Wen Huanga, Chia‑Hui Chewa, Feng‑Chun Hsua, Shih‑Kai Hunga,b*
aDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; bSchool of Medicine, Tzu Chi University, Hualien, Taiwan; cInstitute of Molecular Biology, National Chung Cheng University, Chiayi, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: Recently, Stereotactic Body Radiotherapy (SBRT) has been suggested for managing hepatocellular carcinoma (HCC) curatively. Thus, we conducted this clinical study to evaluate retrospectively the effect of individualized audio‑visual (AV) coaching, respiratory modulated SBRT. Materials and Methods: Between 2014 and 2018, 29 patients with inoperable Barcelona Clinic Liver Cancer (BCLC) stage 0‑B HCC received AV coaching, respiratory‑modulated SBRT. We constructed a task‑oriented multidisciplinary team to establish a standard operation process of respiratory modulation procedures and developed our AV coaching devices. In the training period, a goodness‑of‑fit test was applied individually. SBRT was delivered with a total dose of 40–54 Gy in 5–6 fractions individually. Freedom from local progression (FFLP) and overall survival (OS) were estimated using SPSS (version 17, SPSS Inc., Chicago, IL, USA) life tables. Results: The patient characteristics were as follows: 32.7 ± 16 mm in maximum tumor diameter (range 11–94); BCLC stage 0: 3.4%, BCLC A: 48.3%, BCLC B: 48.3%; Child‑Pugh classification A: 86.2%, Child‑Pugh classification B: 13.8%, and a median of 2 prior liver‑directed treatments (range 0–7). One‑, 2‑, and 3‑year rates of FFLP of SBRT were 96.6%, 96.6%, and 96.6%, respectively. One‑, 2‑, and 3‑year rates of OS were 81.5%, 72.4%, and 67.2%, respectively. No adverse event (AE) occurred in 41.4% of patients, 48.3% developed grade (G) 1–2 AE, 10.3% had G3 AE and none had G4‑5 AE. Conclusion: Respiration‑modulated SBRT is a promising noninvasive treatment option for patients with inoperable and localized HCC. Our data show that SBRT provides comparable tumor control to historical curative options like surgery and radiofrequency ablation of localized tumors. Thus, we are conducting a further prospective clinical trial with the intent to demarcate the clinical effectiveness of SBRT in a larger population of patients with HCC.
Keywords: Hepatocellular carcinoma, Stereotactic ablative radiotherapy, Stereotactic body radiation therapy
