Middle East Journal of Cancer

Stereotactic Body Radiotherapy in Bulky Hepatocellular Carcinoma with or without Portal Vein Thrombosis: A Feasibility Review in an Egyptian Cohort

Document Type : Brief Report(s)

Authors

Mohamed Wahba Hegazy 1
Hany Attallah 2
Khaled M. El-Shahat 3
Emad Mostafa 4
Adel Yassin 3
Ibraheem Haggag 4
Talaat Fathy 5
Sameh M. Abdel Monem 5
Ahmed Abdelmoaty 5
Ahmed A. Bessar 6

1 Department of Clinical Oncology and Nuclear Medicine, Medicine College, Zagazig, Egypt

2 Department of Radiation Oncology, International Medical Center (IMC), Cairo, Egypt

3 Department of Clinical Oncology, Al-Azhar College of Medicine, Cairo, Egypt

4 Medical Radiation Physics, International Medical Center, Cairo, Egypt

5 Tropica Department, College of Medicine, Zagazig, Egypt

6 Radiology Department, College of Medicine, Zagazig, Egypt

https://doi.org/10.30476/mejc.2023.98866.1918
Abstract
Background: Hepatocellular carcinoma (HCC) complicated by portal vein thrombosis presents significant clinical challenges. This study aims to retrospectively assess the feasibility of stereotactic irradiation for treating bulky HCC, with or without vascular invasion.
Method: In this retrospective analysis, the radiotherapy treatment plans and clinical follow-up data of 22 patients diagnosed with HCC, with or without portal vein thrombosis, were reviewed. These patients underwent stereotactic body radiation therapy (SBRT) between September 2019 and September 2022. Treatment involved administering 40-50 Gy in 5 fractions using SBRT with volumetric modulated arc therapy (VMAT)/4D-computed tomography. Descriptive statistics were utilized without the application of statistical tests.
Results: The mean age of the patients was 65 years, with 77% being male. Portal vein thrombosis was present in 73% of the cases, and the average tumor size was 7.2 cm (range 5-12 cm). 59% of patients were classified as Child-Pugh B. The median follow-up duration was 8 months (range 3-36 months). At 3 months, tumor response assessments revealed that 59% of patients had a partial response and 41% had stable disease; by 6 months, 37% achieved complete response, 26% maintained a partial response, and 37% had stable condition. Failure patterns included intrahepatic failure in two patients (at 7 and 9 months) and extrahepatic loss in two others (at 6 and 10 months). Radiation-induced liver disease occurred in two patients at 9- and 11-weeks post-treatment, respectively. Liver cancer-specific mortality was 13.6%, while non-liver cancer-specific mortality stood at 9%. The progression-free survival rate was 82%.
Conclusion: SBRT via VMAT represents a highly cost-effective, non-invasive local therapy with a favorable therapeutic ratio for treating bulky HCC cases, with or without vascular invasion.

Highlights

Mohamed Wahba Hegazy (Scopus)

Keywords

Stereotactic
Hepatocellular
Portal
Veins
Thrombosis
Subjects

How to cite this article:

Hegazy MW, Attallah H, El- Shahat KM, Mostafa E, Yassin A, Haggag I, et al. Stereotactic body radiotherapy in bulky hepatocellular carcinoma with or without portal vein thrombosis: A feasibility review in an Egyptian cohort. Middle East J Cancer. 2024;15(3):242- 48. doi:10.30476/mejc.2023.98866.1918.

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. doi: 10.3322/caac.21660.
  2. Apisarnthanarax S, Barry A, Cao M, Czito B, DeMatteo R, Drinane M, et al. External beam radiation therapy for primary liver cancers: An ASTRO clinical practice guideline. Pract Radiat Oncol. 2022;12(1):28-51. doi: 10.1016/j.prro.2021.09.004.
  3. Hong TS, Wo JY, Yeap BY, Ben-Josef E, McDonnell EI, Blaszkowsky LS, et al. Multi-institutional phase II study of high-dose hypofractionated proton beam therapy in patients with localized, unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol. 2016;34(5):460-8. doi: 10.1200/JCO.2015.64.2710.
  4. Ohri N, Tomé WA, Méndez Romero A, Miften M, Ten Haken RK, Dawson LA, et al. Local control after stereotactic body radiation therapy for liver tumors. Int J Radiat Oncol Biol Phys. 2021;110(1):188-95. doi: 10.1016/j.ijrobp.2017.12.288.
  5. Yoon SM, Ryoo BY, Lee SJ, Kim JH, Shin JH, An JH, et al. Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs. sorafenib in hepatocellular carcinoma with macroscopic vascular invasion: a randomized clinical trial. JAMA Oncol. 2018;4(5):661-9. doi: 10.1001/jamaoncol.2017.5847.
  6. Bujold A, Massey CA, Kim JJ, Brierley J, Cho C, Wong RK, et al. Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol. 2013;31(13):1631-9. doi: 10.1200/JCO.2012.44.1659.
  7. Tanguturi SK, Wo JY, Zhu AX, Dawson LA, Hong TS. Radiation therapy for liver tumors: ready for inclusion in guidelines? 2014;19(8):868-79. doi: 10.1634/theoncologist.2014-0097.
  8. Velec M, Haddad CR, Craig T, Wang L, Lindsay P, Brierley J, et al. Predictors of liver toxicity following stereotactic body radiation therapy for hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2017;97(5):939-46. doi: 10.1016/j.ijrobp.2017.01.221.
  9. Parzen JS, Hartsell W, Chang J, Apisarnthanarax S, Molitoris J, Durci M, et al. Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group. Radiat Oncol. 2020;15(1):255. doi: 10.1186/s13014-020-01703-3.
  10. Culleton S, Jiang H, Haddad CR, Kim J, Brierley J, Brade A, et al. Outcomes following definitive stereotactic body radiotherapy for patients with Child-Pugh B or C hepatocellular carcinoma. Radiother Oncol. 2014;111(3):412-7. doi: 10.1016/j.radonc.2014.05.002.
  11. Que J, Kuo HT, Lin LC, Lin KL, Lin CH, Lin YW, et al. Clinical outcomes and prognostic factors of cyberknife stereotactic body radiation therapy for unresectable hepatocellular carcinoma. BMC Cancer. 2016; 16:451. doi: 10.1186/s12885-016-2512-x.
  12. Lo CH, Huang WY, Lee MS, Lin KT, Lin TP, Chang PY, et al. Stereotactic ablative radiotherapy for unresectable hepatocellular carcinoma patients who failed or were unsuitable for transarterial chemoembolization. Eur J Gastroenterol Hepatol. 2014;26(3):345-52. doi: 10.1097/MEG.0000000000000032.
  13. Lasley FD, Mannina EM, Johnson CS, Perkins SM, Althouse S, Maluccio M, et al. Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy. Pract Radiat Oncol. 2015;5(5):e443-e449. doi: 10.1016/j.prro.2015.02.007.
  14. Gkika E, Schultheiss M, Bettinger D, Maruschke L, Neeff HP, Schulenburg M, et al. Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma. Radiat Oncol. 2017;12(1):116. doi: 10.1186/s13014-017-0851-7.
  15. Chopra S, George K, Engineer R, Rajamanickam K, Nojin S, Joshi K. et al. Stereotactic body radiotherapy for inoperable large hepatocellular cancers: results from a clinical audit. Br J Radiol. 2019;92(1101):20181053. doi: 10.1259/bjr.20181053.
  16. Seo YS, Kim MS, Yoo SY, Cho CK, Choi CW, Kim JH, et al. Preliminary result of stereotactic body radiotherapy as a local salvage treatment for inoperable hepatocellular carcinoma. J Surg Oncol. 2010;102(3):209-14. doi: 10.1002/jso.21593.
  17. Beaton L, Dunne EM, Yeung R, Rackley T, Weber B, Mar C, et al. Stereotactic body radiotherapy for large unresectable hepatocellular carcinomas - a single institution phase II study. Clin Oncol (R Coll Radiol). 2020;32(7):423-32. doi: 10.1016/j.clon.2020.01.028.

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