2010 - Safety of Liver Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma Following Transarterial Radioembolization

Purpose/Objective(s):

Materials/Methods:

A single institution retrospective chart review identified 83 patients who received SBRT following TARE for HCC in the period 2014-2026. Segmental TARE was delivered using Y90, administered trans arterially with dose adjusted based on macroaggregated albumin (MAA) imaging. SBRT was delivered in 5 fractions. Patients were analyzed for Child-Turcott-Pugh score (CTP), Albumin-Bilirubin (ALBI) score, Model for End-Stage Liver Disease (MELD), and Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grade = 3 events. Repeated measures ANOVA were used to estimate trends in CTP, ALBI and MELD scores over time within the treatment group.

Results:

83 patients met inclusion criteria with a median follow-up of 9.5 months. All patients (100%) underwent SBRT post-TARE. The cohort had a baseline mean CTP of 6.5 and ALBI of -1.97. SBRT was delivered at a median dose of 45 Gy in 5 fractions. Acute Grade =3 toxicity occurred in 10 of 83 patients (12%). Any-grade toxicities included hepatic failure (n=1), gastrointestinal bleeding (n=9), hydrothorax (n=1), diarrhea (n=10), and enteritis (n=1). There were no late (=6 months) post-TARE events. Median OS was 273 days (9.0 months). Repeated-measures ANOVA with Greenhouse–Geisser correction demonstrated an effect of time on CTP scores (p=0.006) and MELD(p=0.009) with early CTP rise which appears to resolve at a later time points whereas MELD demonstrated statistically significant improvement over time. Changes in ALBI scores over time were not statistically significant (p=0.355). These changes did not translate into clinically significant liver decompensation. Trends in median CTP, ALBI, MELD, scores over time post-TARE are shown in Table 1.

Conclusion:

Reirradiation with SBRT following TARE for HCC appears to be well tolerated with acceptable rates of = grade 3 toxicities or liver decompensation, as characterized by CTP or ALBI, MELD scores. These findings should be interpreted in the context of decreasing sample size at later follow-up intervals and warrant confirmation with longer follow-up and dosimetric analysis.