Main Session
Sep
27
PQA 01 - Gastrointestinal Cancer and Central Nervous System
2058 - Stereotactic Body Radiotherapy (SBRT) in Unresectable Hepatocellular Carcinoma (HCC)- Prospective Study
Presenter(s)
Reena Engineer, MD - Tata Memorial Centre, Mumbai, Please Select
R. Engineer1,2, R. K. Sangle3, R. Krishnatry3, S. Gudi3, K. Gala1, R. Singh4, A. Ramaswamy5, V. Ostwal5, S. Patkar4, and M. Goel4; 1Tata Memorial Hospital, Mumbai, India, 2HBNI University, Mumbai, India, 3Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India, 4Tata Memorial Centre, Mumbai, India, 5Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
Purpose/Objective(s):
Advanced HCC not amenable to surgery or TACE are treated with systemic therapy.This study aimed to evaluate the efficacy of stereotactic body radiotherapy (SBRT) with or without systemic therapy for patients with unresectable hepatocellular carcinoma (HCC) not amenable for TACE/RFA.Materials/Methods:
This is single centred prospective non-comparative study that recruited patients with HCC (Child-Pugh Class A5-B7) not amenable to further TACE or surgery. The patients who received systemic therapy (<3 months) either TKI or Immunotherapy, before starting SBRT were also included. Radiation was given either with photon or proton beam with median prescribe dose of 50 Gy (IQR 45-55 Gy). Survival outcomes as overall survival (OS) and Progression free Survival (PFS) were studied with Kaplan Meir Method. Survival rates at 1 and 2 years were noted. The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS) and Local Control (LC).Results:
From September 2022 to July 2025, 75 patients were screened, and 52 patients were enrolled. Of these 14(27%) could not receive SBRT due to liver decompensation (n=6), defaulted for radiation (n=5), progressive disease (n=3). 38 patients who received SBRT were evaluated. Majority patients were BCLC C (60.5%), Child Pugh Class A5(73.7%) with Portal vein tumor thrombosis (PVTT) (65.8%) and viral etiology in 65.8% cases. At median follow-up of 25 months (95% CI: 19.0–36), 1- year and 2-year OS was 77.7% (95% CI: 65.2–92.7%) and 47.5% (95% CI: 31.9–70.6%) respectively. Median OS was 23 months (95%CI: 17-NR). 1- year and 2-year PFS was 67.6% (95% CI: 54–84.6%) and 49.6% (95% CI: 34.7–70.8%) respectively. Median PFS was 21 months (95% CI: 17.0–NR). Majority patient in our study received radiation of BED=100 Gy (68.4%) proving benefit with escalated dose. Systemic therapy was given in 57.9% majority receiving Lenvatinib (50%), TACE in 28.9% while 13.2% received only SBRT. Local control at 2 yrs was seen as 89.3 % (95% CI: 79.9–99.8%). 3 (7.8%) patients had Grade 3 RT related late toxicityConclusion:
Addition of SBRT improves survival outcomes in HCC, with advanced disease and PVTT. Thus it should be a valid treatment option along with systemic therapies in these patients.| Characteristic | Overall (N = 38) |
| Age, mean (SD) | 55.35 (15.21) |
| Gender, n (%) Male Female | 33 (86.8) 5 (13.2) |
| Child-Pugh Class, n (%) | |
| Class A5 Class A6 Class B7 | 28 (73.7) 9 (23.7) 1 (2.6) |
| BCLC Stage, n (%) | |
| Stage 0-A Stage B Stage C | 7 (18.4) 8 (21.1) 23 (60.5) |
| PVTT Status, n (%) | |
| Present Absent | 25(65.8) 13 (34.2) |
| VP Group, n (%) | |
| VP 0-2 VP3 VP4 | 15 (39.5) 8 (21.1) 15 (39.5) |
| Viral Etiology, n (%) | |
| Viral Non-viral | 25 (65.8) 13 (34.2) |
| BED =100 Gy, n (%) | |
| <100 Gy =100 Gy | 12 (31.6) 26 (68.4) |
| Prior TACE | 11 (28.9%) |
| Systemic therapy | 27(71%) |
| Lenvatinib Atezolizumab+ Bevacizumab SBRT alone | 19 (50%) 3 (7.9%) 5 (13.2%) |