Gastrointestinal Cancer

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SU_13_2130 - Effect of Treatment Schedule on Fatigue in Hepatocellular Carcinoma Patients Treated With Stereotactic Body Radiation Therapy

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

Effect of Treatment Schedule on Fatigue in Hepatocellular Carcinoma Patients Treated With Stereotactic Body Radiation Therapy
S. Hasan1, S. Horrigan2, M. W. Packard3, P. Renz1, S. Gresswell1, and A. V. Kirichenko4; 1Allegheny Health Network Department of Radiation Oncology, Pittsburgh, PA, 2Allegheny Heath Network, Pittsburgh, PA, 3Allegheny Health Network, Pittsburgh, PA, 4Boston Consulting Group, Philadelphia, PA

Purpose/Objective(s): Prospective trials have indicated treatment related fatigue to be the most significant acute toxicity affecting quality of life during liver stereotactic body radiotherapy (SBRT). We hypothesize that daily (QD) compared with every other day (QOD) treatment may correlate with a greater incidence of fatigue in SBRT for hepatocellular carcinoma (HCC).

Materials/Methods: From 2009 to 2017, 100 SBRT treatments were delivered to 110 HCC lesions in 91 patients with Child Pugh (CP) A (n=62) or CP-B (n=38) cirrhosis in this IRB-approved study. Patients with CP-C cirrhosis, eastern cooperative oncology group (ECOG) 3 or higher, or a history of ascites or hepatic encephalopathy were excluded. Fatigue was assessed during and up to 1 month after SBRT based on Common Terminology Criteria for Adverse Events version 4.0. Fatigue was assessed against QD vs. QOD treatment as well as several treatment/patient related variables via Chi square testing with odds ratios (OR) and multivariate analysis with a binomial regression model.

Results: Ninety-one HCC patients with Barcelona Clinic Liver Cancer (BCLC) stages 0 (n=10), A (n=32), and B (n=58) were analyzed. Median age was 62. Median follow-up was 18 months. ECOG performance status was 0 (n=44), 1 (n=43), or 2 (n=13). Median tumor diameter was 3 cm (1.1 – 11 cm) with median planning target volume 55 cc (11.5 – 528 cc). The median dose was 45 Gy in 5 fractions (33 to 57 Gy in 4-7 fractions). 65 treatments were QD and 45 were QOD, allowing for up to 2 consecutive non-treatment days for the weekend in each group. Grade 1 and 2 fatigue developed in 49% and 14% of treatments, respectively. Two patients were hospitalized for grade 3 fatigue; notably toxicity screening was positive for ethanol and opioids in one patient and decompensated cirrhosis from disease progression in the other. QD treatment had statistically significant higher level of fatigue (Table 1.). Time of treatment (morning vs. afternoon), biologic equivalent dose, treated volume, CP score, BCLC stage, or performance status were not associated with any level of fatigue. On multivariate analysis, both daily treatment and ECOG>1 were independently associated with grade 1 and 2 fatigue (P<0.05). In a subset analysis between patients with QD vs QOD treatment, there were no differences in patient/disease/treatment characteristics or local control. Table 1. Treatment schedule and Fatigue in SBRT for HCC.
Treatment Schedule Percentage Univariate Analysis Multivariate Analysis
Any Fatigue Everyday 78% P < 0.01 P < 0.01
Every Other Day 44%
Grade 2/3 Fatigue Everyday 22% P = 0.048 P = 0.044
Every Other Day 7.3%

Conclusion: Delivery of SBRT on an every other day basis decreased acute treatment related fatigue without a detriment in disease control. A QOD treatment schedule may improve quality of life in HCC patients already afflicted with sequelae of comorbid cirrhosis.

Author Disclosure: S. Hasan: None. S. Horrigan: None. M.W. Packard: None. P. Renz: None. A.V. Kirichenko: None.

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