Gastrointestinal Cancer

SS 38 - GI 4 - Hepato-Pancreatic-Biliary

280 - Outcomes of SBRT for HCC in Patients With Child-Pugh B and C Cirrhosis

Wednesday, October 24
12:00 PM - 12:10 PM
Location: Room 206

Outcomes of SBRT for HCC in Patients With Child-Pugh B and C Cirrhosis
P. Lee1, and S. Sioshansi2; 1University of Massachusetts Medical School, Worcester, MA, 2Department of Radiation Oncology, University of Massachusetts Memorial Medical Center, Worcester, MA

Purpose/Objective(s): To report outcomes of patients with Child-Pugh B or C (CP B/C) hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT).

Materials/Methods: 60 consecutive patients with HCC amenable to SBRT were prospectively enrolled on study. 23 patients with CP B/C liver disease prior to initiating SBRT were identified. Patients were treated between Nov. 2012 and Feb. 2017. They received 30-50 Gy in 4 or 5 fractions. Data on baseline liver dysfunction, local control (LC), survival, hepatic toxicity and liver transplant outcomes were collected and analyzed.

Results: Of the 23 patients with CP B/C liver disease 3, 6, 9, and 5 patients had CP B7, B8, B9 and C10 disease, respectively. Median follow up (FU) was 12.1 mo (1 – 54.7). Median FU for living patients was 21.9mo (11.8 – 54.7). Median mean liver dose (MLD-ctv) was 7Gy (4-10.4). LC at 6mo and 1y was 94.4% and 90.1%. Median, 6mo, and 1y overall survival (OS) was 12.1mo, 73.9%, and 52.1%. Median OS for CP B7, B9, and C10 groups were 9.2mo, 12.2mo, and 14.4mo, respectively. Median OS for CP B8 patients was not met at time of analysis; 1y survival rate was 66.6% for patients with CP B8. 14 patients were listed for transplant (LT) at the time of SBRT. Eight patients underwent LT and median time from SBRT to transplant was 6.3 mo. Median FU time of the LT patients is 24.7 mo (9.1 – 54.7), with 7 of 8 patients alive and NED at time of analysis. Four patients died while listed; 1 patient was removed, resulting in a drop-out rate of 35.7%. Six patients developed grade 2-3 acute or subacute toxicity including nausea requiring antiemetics, cholecystitis requiring antibiotics, ascites with increased frequency of paracentesis, and IVC and PV thrombosis. 17 patients tolerated treatment well without acute or subacute grade 2 or higher toxicity. Ten, 7 and 5 patients had CP progression, CP stability, and CP improvement at 6mo.

Conclusion: Treatment options for HCC in patients with advanced cirrhosis are limited due to a complicated disease state. There is little published data to support the use of SBRT in patients with CP B7 disease and scant evidence in CP ≥B8 disease. From our experience treating patients with CP B7-C10 cirrhosis, SBRT provides excellent LC and encouraging OS. A third of patients were successfully bridged to LT. Treatment was well tolerated; less than half of patients had CP progression within six months after SBRT. MLD was frequently the dose limiting factor. Guidelines recommend MLD-ctv <6 Gy in CP B patients. However, this was not feasible in 12 of our patients, resulting in a median MLD-ctv of 7Gy. Despite higher than recommended MLD, patients tolerated treatment well.
All pts CP 7 CP 8 CP 9 CP 10
No pts. 23 3 6 9 5
Etiology of Liver Dz
EtOH 16 1 3 7 5
HCV 11 1 3 5 2
HBV 1 0 0 1 0
NASH 2 1 1 0 0
PBC 1 0 1 0 0
Median tumor size 3.1 cm (1-10) 4 cm 2.7 cm 2.6 cm 3.2 cm
Median MLD-ctv 7 Gy (3.1-10.4) 8.8 Gy 8 Gy 5.4 Gy 4.8 Gy
CP Progression 10 2 1 3 4
CP Stability 7 1 3 3 0
CP Improvement 5 0 1 3 1
Grade 2/3 AEs 6 2 1 2 1
1y Survival 52.10% 33% 66% 44.40% 60%
Median OS 12.1 mo (1-54.7) 9.2 mo Not Met 12.2 mo 14.4 mo
OLT 8 2 2 2 2

Author Disclosure: P. Lee: None. S. Sioshansi: None.

Peter Lee, BS

Disclosure:
No relationships to disclose.

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