8Gy Single Fraction (8Gy/1Fr) Palliative Radiotherapy (RT) For Hepatocellular Carcinoma (HCC): Safety And Efficacy

Abstract

8Gy/1Fr palliative RT has shown promising evidence on symptom palliation in advanced HCC, however, its efficacy in disease control and safety has not been reported. Herein we reported our experience on 8Gy/1Fr palliative RT. From year 2013–2015, 37 consecutive HCC patients received 8Gy/1Fr palliative RT were analysed; Patients were followed up regularly, radiation related side effects, symptom, serum alphafetoprotein level (AFP) and liver function were monitored. The primary endpoint was AFP response. Secondary endpoints were physician reported symptom response and safety in terms of Child Purge (CP) progression. At the time of analysis 1 patient was alive and median follow-up time was 5.6 months. Patients’ and tumour characteristics were as follows: median age 61 (41–88), male: female (n = 31/6). ECOG0/1/2/ (n:1/23/ 13); Baseline CP score: A/B (n:26/11) BCLC stage B/C (n: 1/36). Cause of cirrhosis: chronic alcoholism/Hepatitis C/Hepatitis B, (n = 8/1/28); Median diameter of tumour 13 cm (6–19.4 cm); main portal vein thrombosis (PVT)/ branch PVT (n: 8/8). Presence of extrahepatic disease: n = 14 (37.8%); ≥3 liver lesions: n = 21 (56.8%). Previous treatment received before RT: TACE/SBRT/hepatectomy (n:13/2/2). Treatment after RT: Sorafenib /hepatectomy/ TACE/SBRT/ RFA/immunotherapy (n:16/1/3/5/1/1) Concerning safety,1 patient with heavy disease burden (18 cm tumour, CP 8) died within 1 week of treatment. 7 (18.9%) patients had CP progression within 1 month of RT. Only 1 (2.7%) patient reported Grade 3 toxicity (fatigue). The most common side effect was nausea: Grade1/2 (n = 5/1). 10 (27%) patients had physician reported symptom response. Median survival from diagnosis and start of RT was 5.6 and 4.2 months respectively. 14 patients (37.8%) had significant AFP drop after RT, Median days to reach AFP nidar was 41 days. In our early experience, 8Gy/1Fr palliative RT achieves promising median survival and AFP response in advanced HCC patients. It is a safe and effective means for symptom palliation and disease control which allowed many patients to receive subsequent liver directed treatment.