Does HCC Etiology Impact the Efficacy of Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma? An Asian Liver Radiation Therapy Group Study

Abstract

Nalee Kim,1,* Jason Chia-Hsien Cheng,2,* Nitin Ohri,3 Wen-Yen Huang,4 Tomoki Kimura,5 Zhao Chong Zeng,6 Victor Ho Fun Lee,7 Chul Seung Kay,8 Jinsil Seong9 1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan School of Medicine, Seoul, Republic of Korea; 2Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan; 3Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; 4Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan; 5Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima, Japan; 6Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 7Department of Radiation Oncology, The University of Hong Kong, Hong Kong; 8Department of Radiation Oncology, Jeju Halla Hospital, Jeju, Republic of Korea; 9Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea*These authors contributed equally to this workCorrespondence: Jinsil Seong, Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, Tel [phone], Fax [phone], Email [email protected]/Purpose: The Asian Liver Radiation Therapy Study Group has formed a large and detailed multinational database of outcomes following stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC). Here, we explored the potential impact of HCC etiology on SBRT efficacy. Tumor control probability (TCP) models were established to estimate the likelihood of local control (LC).Methods: Data from 415 patients who were treated with SBRT for HCC were reviewed. Cox proportional hazards models were used to identify key predictors of LC. TCP models accounting for biologic effective dose (BED) and tumor diameter were generated to quantify associations between etiology and LC.Results: Cox models demonstrated that hepatitis C virus (HCV) infection was associated with favorable LC following SBRT (HR=0.52, 95% CI 0.04– 0.96, p=0.036). The 2-year LC rate for patients with HCV etiology was 88%, compared to 78% for other patients. Small tumor and high BED were also associated with favorable LC. TCP models demonstrated a 10– 20% absolute increase in predicted LC across the range of SBRT doses and tumor sizes.Conclusion: We found a novel association between HCV status and LC after SBRT for HCC that warrants further exploration. If validated in other datasets, our findings could help clinicians tailor SBRT schedules.Graphical Abstract: Keywords: tumor control probability, hepatocellular carcinoma, stereotactic body radiation therapy, hepatitis C virus

Keywords

• tumor control probability
• hepatocellular carcinoma
• stereotactic body radiation therapy
• hepatitis c virus.