Beschreibung:
<jats:p> 322 </jats:p><jats:p> Background: Stereotactic body radiotherapy (SBRT) has an emerging role for patients with hepatocellular (HCC). The purpose of this study is to describe the efficacy of HCC SBRT at a population level without any tumor size restriction. Methods: A retrospective study of the first 49 HCC patients treated with SBRT between March 2011-July 2015 at the British Columbia Cancer Agency was conducted. All patients were either ineligible for or failed standard local therapies (partial hepatectomy, radiofrequency ablation, percutaneous ethanol injection, transarterial chemoembolization, or radioembolization) and discussed in a multidisciplinary rounds setting. Local control (LC), progression free survival (PFS) (defined as freedom from failure elsewhere in the liver) and overall survival (OS) were analyzed at 1 and 2 years. Changes to Child’s Pugh (CP) score at 3 months post-SBRT were also analyzed. Results: Median follow-up was 14 months with 35 patients (71%) alive at last follow-up. Fifty-two separate HCC lesions were treated with a median size of 4.2 cm (range: 1.3-15.6 cm) and a planning treatment volume (PTV) of 114 cm<jats:sup>3</jats:sup> (range: 22-1776 cm<jats:sup>3</jats:sup>). Over half of the lesions (55%) were ≥ 4cm. Thirty-six patients (74%) had previous local therapies. Prior to SBRT, 57% of patients were CP A5, 33% were CP B6, 8% were CP B7, and 1 patient (2%) was CP B8. At 3 months post-SBRT, 35% of patients had an increased CP score, with a mean increase of 1.8 points. The most common dose and fractionation was 45Gy in 3 or 5 fractions. Median V90 (dose to 90% of the PTV) was 99.8% (range: 74.1-100%). LC for all patients was 96% at 1 and 2 years. LC was comparable between moderate to large tumors ( ≥ 4cm) and those < 4cm (1 and 2 year LC: 96% for ≥ 4cm vs 95% for < 4cm). OS for all patients at 1 year was 67% and 62% at 2 years. PFS was 53% and 38% at 1 and 2 years respectively. The median PFS was 13.7 months with 13 patients (27%) undergoing further local treatment due to regional progression including 4 patients who had liver transplants. Conclusions: SBRT provides high local control for patients with HCC of even moderate to large size. Regional progression is prominent in HCC patients and SBRT does not appear to preclude further local treatments. </jats:p>