Clinical observation of cyberknife stereotactic body radiation therapy for unresectable large hepatocellular carcinoma

Abstract

Abstract: Objective To evaluate the efficacy and security of Cyberknife stereotactic body radiotherapy (SBRT) for unresectable large hepatocellular carcinoma (HCC) and analyze the prognostic factors affecting outcomes. Methods From January 2012 to December 2014, 97 patients with un-resectable large HCC treated with Cyberknife SBRT were retrospectively analyzed. The median size of tumors was 6.2cm (5.0~9.8 cm), Doses ranged from 40 Gy to 56 Gy were given in 5 to 11 fractions for 5 to 10 consecutive days. Overall survival rate (OS), progression free survival rate (PFS) and local control rate were calculated according to the Kaplan-Meier method. Cox proportional hazard models was used to analyze the prognostic factors for survival. Toxicity was evaluated according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v.4.03. Results A total of 97 patients were enrolled in this study. Based on Response Evaluation and Criteria in Solid Tumors (RECIST). The Objective response rate (ORR) was achieved in 64.95%. The disease control rate (DCR) was achieved in 80.41%. The local control rate at 1-, 2-, 3- and 5-years was 92.3%, 88.2% , 88.2% and 88.2%, respectively. Median OS was 30 months, and OS at 1-, 2-, 3- and 5-years was 77.3%, 57.7%, 43.3% and 27.8%, respectively, while PFS rates at 1-, 2-, 3- and 5-years were 33.7%, 21.7%, 14.0% and 6.4%. Median PFS was 8 months. Multivariate analysis revealed that Child-Pugh score and Portal vein tumor thrombosis were independent predictors of OS. Acute toxicities were mild and well tolerated. Conclusion Cyberknife SBRT is a non-invasive, safe and equally effective treatment for large HCCs with relatively low risk of severe toxicity. Child-Pugh score and Portal vein tumor thrombosis were associated with survival rate of patients after SBRT. These results suggested that Cyberknife SBRT can be a good alternative treatment for large HCCs which is unsuitable for standard treatment.

Key words: Hepatocellular carcinoma, Stereotactic body radiotherapy, Cyberknife, Efficacy, Prognostic factors

WAN Zhi-qing, WANG Quan, SUN Jing, CHANG Xiao-yun, ZHANG Ai-min, LI Wen-gang, DUAN Xue-zhang. Clinical observation of cyberknife stereotactic body radiation therapy for unresectable large hepatocellular carcinoma[J]. Chinese Hepatolgy, 2025, 30(4): 431-434.

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