Cancer Research, Statistics, and Treatment (Sep 2024)

Bridging hope: Retrospective analysis of stereotactic radiotherapy in patients with hepatocellular carcinoma-A promising and cost-effective solution for low-and middle-income countries

  • Rakesh Kapoor,
  • Treshita Dey,
  • Divya Khosla,
  • Sunil Taneja,
  • Naveen Kalra,
  • Rajesh Gupta

DOI
https://doi.org/10.4103/crst.crst_413_23
Journal volume & issue
Vol. 7, no. 3
pp. 326 – 333

Abstract

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Background: Hepatocellular carcinoma (HCC) is one of the most common cancers among men in India. Stereotactic body radiation therapy (SBRT) has recently become a promising treatment modality for HCC before liver transplantation. Objectives: In this retrospective study, we aimed primarily to determine the clinical details of patients with HCC and response of SBRT in treating such patients with a secondary objective of assessing the impact of SBRT on patient survival. Materials and Methods: This retrospective analysis was conducted from January 2016 to January 2019 at the Department of Radiotherapy at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Six MV photons were used in conjunction with volumetric modulated arc treatment to deliver SBRT. Tumor response was evaluated as per the Response Evaluation Criteria in Solid Tumors (RECIST) criteria. For both overall survival (OS) and progression-free survival (PFS), Kaplan–Meier curves were created. Results: We included 21 patients with HCC who received SBRT treatment. The median age of our patients was 63 (45–74) years. The radiation dose ranged from 36–50 Gy in 3–5 fractions. Of the 21 patients, 5 (23.8%) had a complete response, whereas 9 (42.9%) showed a partial response. After 2 years, the local control rate was 66.7%. The overall survival was 28 months (interquartile range, IQR, 22–37), and the median progression-free survival was 20 months (IQR, 16–27). The overall survival rate at 2 years was 59%. There was no treatment-related mortality observed and no patient required an urgent transplant for acute decompensation. Conclusion: SBRT was well tolerated by our patients. With advancements in external beam radiotherapy (EBRT) techniques, it is possible to practice higher dose fractionation regimens due to more precise targeting and sparing of normal liver tissue. Considering the long waiting period for liver transplantation, liver SBRT can prove to be a successful bridging tool.

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