Stereotactic Body Radio Therapy for Inoperable Large Hepatocellular Cancers: Results from a Clinical Audit

Objectives: To evaluate the outcomes of stereotactic radiotherapy (SBRT) in the treatment of inoperable hepatocellular carcinomas (HCC) that are unsuitable for, or refractory to other liver-directed therapies. Methods: Between March 2015 and June 2018, patients with primary HCCs refractory to or unsuitable for treatment with other liver-directed therapies were treated with SBRT. Patients of Child status A5-B7 and with normal liver reserve >= 700 cc were preferred. Local control (LC), overall survival (OS), progression free survival (PFS) and effect of prognostic factors were analysed. Results: 21 patients with inoperable HCCs were treated. The median tumour diameter was 9.6cm (5-21) and median tumour volume was 350 cc (32.9 - 2541). median SBRT dose prescription was 42Gy/6 fractions (25 - 54Gy/6#). The 1- and 2-year LC rate was 88 and 43 % respectively. Overall rate of >= grade III toxicity was 14 %. Patients with Child A5 liver function had a better median OS than A6 and B7 patients [21 vs 11 vs 8 months]. Also, tumours with GTV < 350 cc volumes had a better OS compared to GTV of greater than 350 cc [24 months vs 8 months, p value = 0.004]. Conclusions: This study showed that SBRT can be used safely and effectively to treat inoperable HCCs with or without prior loco-regional therapies, resulting in good local control and survival with acceptable toxicity. Advances in knowledge: Use of SBRT in inoperable HCC is safe and effective.