Journal of Hepatocellular Carcinoma (Mar 2024)

Biochemical Safety of SBRT to Multiple Intrahepatic Lesions for Hepatocellular Carcinoma

  • Hall JT,
  • Moon AM,
  • Young M,
  • Tan X,
  • Darawsheh R,
  • Danquah F,
  • Tepper JE,
  • Yanagihara TK

Journal volume & issue
Vol. Volume 11
pp. 443 – 454

Abstract

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Jacob T Hall,1 Andrew M Moon,2,3 Michael Young,1 Xianming Tan,3,4 Rami Darawsheh,5 Flora Danquah,3 Joel E Tepper,1,3 Ted K Yanagihara1,3 1Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA; 2Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA; 3Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC, USA; 4Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; 5University of North Carolina School of Medicine, Chapel Hill, NC, USACorrespondence: Ted K Yanagihara, Department of Radiation Oncology, 101 Manning Drive CB #7512, Chapel Hill, NC, 27514, USA, Tel +1-984-974-0400, Email [email protected]: We aim to better characterize stereotactic body radiation therapy (SBRT)-related hepatic biochemical toxicity in patients with multiple intrahepatic lesions from hepatocellular carcinoma (HCC).Methods: We conducted a retrospective analysis of patients with HCC who underwent SBRT for 2 or more synchronous or metachronous liver lesions. We collected patient characteristics and dosimetric data (mean liver dose [MLD], cumulative effective volume [Veff], cumulative volume of liver receiving 15 Gy [V15Gy], and cumulative planning target volume [PTV]) along with liver-related toxicity (measured by albumin-bilirubin [ALBI] and Child–Pugh [CP] scores). A linear mixed-effects model was used to assess the effect of multi-target SBRT on changes in ALBI.Results: There were 25 patients and 56 lesions with median follow-up of 29 months. Eleven patients had synchronous lesions, and 14 had recurrent lesions treated with separate SBRT courses. Among those receiving multiple SBRT courses, there were 7 lesions with overlap of V15Gy (median V15Gy overlap: 35 mL, range: 0.5– 388 mL). There was no association between cumulative MLD, Veff, V15Gy, or PTV and change in ALBI. Four of 25 patients experienced non-classic radiation-induced liver disease (RILD), due to an increase of CP score by ≥ 2 points 3 to 6 months after SBRT. Sixteen of 25 patients experienced an increase in ALBI grade by 1 or more points 3 to 6 months after SBRT. Comparing the groups that received SBRT in a single course versus multiple courses revealed no statistically significant differences in liver toxicity.Conclusion: Liver SBRT for multiple lesions in a single or in separate courses is feasible and with acceptable risk of hepatotoxicity. Prospective studies with a larger cohort are needed to better characterize safety in this population.Keywords: HCC, SBRT, reirradiation, multi-site, toxicity

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