Gastrointestinal Cancer

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SU_14_2137 - Stereotactic Body Radiation Therapy for Centrally Located Hepatocellular Carcinoma: Outcomes and Toxicities

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Stereotactic Body Radiation Therapy for Centrally Located Hepatocellular Carcinoma: Outcomes and Toxicities
S. Lazarev1, C. Hardy2, O. Factor2, K. Rosenzweig2, and M. Buckstein3; 1Icahn School of Medicine at Mount Sinai Department of Radiation Oncology, New York, NY, 2Icahn School of Medicine at Mount Sinai, New York, NY, 3Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY

Purpose/Objective(s): Treatment of centrally located hepatocellular carcinoma (CL-HCC) with stereotactic body radiation therapy (SBRT) remains a significant challenge for radiation oncologists managing this disease. Currently, there is paucity of data on hepatobiliary toxicity (HBT) and clinical outcomes after irradiation of CL-HCC. This study aimed to assess safety and efficacy of SBRT for CL-HCC.

Materials/Methods: We identified 53 patients with CL-HCC treated with SBRT in the period of 2011-2017 in our institution. CL-HCC was defined as a tumor sited in segments 4, 5, or 8, adjacent to the hepatic hilum, or <1 cm from main portal branches. Primary endpoints were treatment response (TR), local control (LC), and HBT. TR was assessed using Modified Response Evaluation Criteria in Solid Tumors (mRECIST). Secondary endpoints included disease progression outside of SBRT treatment field, disease-specific survival (DSS), and overall survival (OS). LC and survival were examined using the Kaplan-Meier and log-rank methods. HBTs were assessed using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0. Multivariable logistic regression models were used to evaluate for predictors of grade ≥3 AEs.

Results: Median age was 65 years. 33 (62.3%) patients had Child-Turcotte-Pugh (CTP) score A, 20 (37.77%) - score B. Albumin-Bilirubin (ALBI) grade 1 constituted 6 (11.3%) cases, grade 2 – 32 (60.4%), grade 3 – 15 (28.3%). The majority of patients had pre-treatment AFP ≤500 - 37 (69.8%), and tumor ≤50 mm – 42 (79.3%). A median total dose of 40 Gy was delivered in a median of 5 fractions. Median BED3 and BED10 were 146.7 Gy and 72 Gy, respectively. Complete/partial response was observed in 40 (75.5%) lesions, stable disease - in 9 (17.0%), and progression – in 4 (7.5%). At a median follow-up of 12.2 months, there were 6 (11.3%) local failures. The actuarial 2-year LC rate was 87.9%. LC was better with higher BED10 (>70 vs ≤70 Gy) 96.9% vs 72.5%, p=0.01, and among non-Hispanic 92.9% vs 66.7% Hispanic patients, p=0.03. LC rates did not differ between pre-treatment ALBI grades, CTP scores, or AFP (≤500 vs >500). At the time of analysis, 26 (49.1%) patients developed disease progression outside of SBRT field. A total of 30 (56.6%) deaths were recorded; 20 (37.7%) patients died of HCC. The 2-year rates for disease progression outside of SBRT field, DSS, and OS rates were 44.5%, 53.2%, and 39.1%, respectively. The incidence of any Grade ≥3 AE was 17.0% (9 of 53), most of which (n=6) were grade 3. There were no grade 5 AEs. Five of 9 AEs were acute (≤ 60 days). There was a trend toward an increased risk of grade ≥3 AE with mean liver dose >10 Gy (OR 8.46, p=0.07).

Conclusion: In the present cohort, the majority of patients had pre-treatment CTP score A, ALBI grade ≤2, AFP ≤500, and tumors ≤50 mm. In this context, SBRT to a total median dose of 40 Gy produced excellent TR with relatively favorable side effect profile and LC. Select HCC patients who are not candidates for surgery or other locoregional therapies can be considered for SBRT to the central liver.

Author Disclosure: S. Lazarev: None. C. Hardy: None. O. Factor: None. K. Rosenzweig: None. M. Buckstein: None.

Stanislav Lazarev, MD

Mount Sinai Health System

Biography:
I am currently a Chief Resident in Radiation Oncology at Mount Sinai Hospital in New York, NY. My research interests lie in the field of head and neck malignancies, pediatric tumors, LDR-brachytherapy for prostate cancer, and SBRT for hepatocellular carcinoma. My clinical interests are broad, and include treatment of pediatric malignancies, gynecologic, head and neck, and gastrointestinal cancers.

I grew up in the south of Russia where I studied foreign languages at a linguistic university. At the age of 21, I moved to California where in 2009 I graduated from UC Berkeley with a BA in biochemistry and molecular biology. I received my medical degree at University of Vermont College of Medicine in 2014, and then returned to the Bay Area to complete a medicine internship at Highland Hospital in Oakland. In 2015 I joined the Radiation Oncology Residency Program at Mount Sinai. Outside of medicine, I enjoy learning foreign languages, playing the piano, traveling abroad, and playing soccer.

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