Assessment Of Response Following Combination Deb-Tace And Sbrt For Unresectable Hepatocellular Carcinoma

For unresectable hepatocellular carcinoma (HCC) with favorable characteristics (Barcelona Clinic Liver Cancer (BCLC) B), trans-arterial chemoembolization (TACE) is the standard of care for locoregional treatment with a survival benefit. Yet, complete response of lesions with TACE is not always achieved, prompting use of adjuvant therapies to TACE. We review outcomes following stereotactic body radiation therapy (SBRT) as an adjuvant therapy following TACE. Patients with HCC treated with TACE and SBRT from 2010-2014 were included. TACE was administered with Drug Eluting Beads (DEB). SBRT was defined as any external beam radiation greater than 30 Gy in 5 or fewer fractions with stereotactic guidance. Patients needed to have at least one post-SBRT contrast enhanced study to assess response to be included. SBRT was administered as a planned treatment following TACE or as a salvage therapy. Objective response was measured using modified Response Evaluation Criteria in Solid Tumors (mRECIST). Local control (LC) was defined as lack of progression in the treated lesion. T-test and log-rank were used to compare treatment parameters. One hundred patients with 107 individual treated lesions met inclusion criteria. Of these, 96 lesions were identified with a least one imaging study to assess response. Median age was 62 years (range 42-83). Patient characteristics are recorded in Table 1. Median follow up for response was 6.2 months (range 0.5-39.3). Median time between TACE and completing SBRT was 65 days (range 12-2164). Median number of TACEs to the target lesion prior to SBRT was 2 (range 1-7). Median SBRT dose was 40 Gy in 5 fractions (range 30-50). Median lesion size was 2.95cm (range 1.2-9.4). Median AFP was 15.3. Overall mRECIST objective response rate was 85.4%: 58.3% complete response (CR), 27.1% partial response (PR), 8.3% stable disease (SD), and 6.3% progression of disease (PD). Median time to achieve a CR was 3.2 months (range 0.5-18), and patients often required repeat imaging before a CR was achieved. LC in the treated lesion at 1 year was 92.2% and 86.1% at 2 years. No statistically significant association between CR or LC was found with lesion size, AFP, or whether the SBRT was salvage or planned. Twenty patients (21%) went to liver transplant. Overall survival was 66.5% at 1 year and 57.1% at 2 years. Combination DEB-TACE and SBRT for unresectable HCC shows favorable objective response, LC, and successful bridging to transplant. This paradigm is currently being studied in a prospective phase II trial.Poster Viewing Abstracts 2414; Table 1ECOG Performance Score: 043.8%146.9%24.2%Child-Turcotte-Pugh Score: A54.1%B40.6%C1%BCLC Stage: A26%B58.3%C8.3% Open table in a new tab