STEREOTACTIC RADIOSURGERY FOR THE TREATMENT OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH ADVANCED CIRRHOSIS. PRELIMINARY REPORT.Room: Hall C
Daniel G Maluf, Shiyu Song, Bridgette Williams, Richard T Stravitz, Richard Sterling, Mitchel Shiffman, Adrian H Cotterell, Marc P Posner, Douglas Heuman, HoChong Gilles, Stanley H Benedict, Velimir A Luketic, Robert A Fisher. Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA; Oncology Radiology, Virginia Commonwealth University, Richmond, VA; Medicine/Hepatology, Richmond Veterans Affairs Medical Center, Richmond, VA.
Background: The use of external bean radiation therapy for the treatment of Hepatocellular Carcinoma (HCC) has been limited by the low radiation tolerance of the surrounding cirrhotic liver. The goal of this study is to investigate the utility of stereotactic radiosurgery (SS) in the treatment patients with advance cirrhosis and small (<5 cm) HCC.
Material and Methods: This prospective study was approved for the VCU IRB. Written informed consent was required. Eligibility criteria were: Age >20, <80; solitary liver tumor < 5 cm, Child-Pugh B-C cirrhosis, no indication for surgery or other ablation therapy; elevated AFP (> 12 ng/dl).
Results: Three female and one male received treatment with SS. Mean age of 60 +/ 10.6 years old. Primary disease include: HCV, HBV, cryptogenic and alcoholic cirrhosis. All patients were Child Pugh C and had single tumors with a mean of 2.0 +/- 0.5 cm in size. Mean pre-treatment alpha feto protein of the group was 1223.0 +/- 1581 ng/dl. Pts received treatment as outpatient in one week and a mean total dose of 36 +/- 6 Gy per patient in out-patient setting. No major or minor complications were seen at a mean of 14 +/- 7 months follow up. Two months post treatment mean AFP was 61.2 +/-74 ng/dl and the liver MRI showed partial (>70%) or total lost of gadolinium enhancement in all patient. One patient received post-treatment OLTx. Explanted liver showed complete treatment of the targeted lesion (100% necrosis). AFP level fell by 95 +/- 3.6% after treatment was completed. No minor or mayor complications were observed.
Conclusion: SS appears to be safe and effective for the treatment of HCC in severely cirrhotic (Child B, C) patients. Treatment was done in out-patient setting and can be considered as another therapeutic option to be added to the HCC ablation armamentarium. A longer follow-up in a prospective cohort of patients are needed to confirm this result. Patient selection criteria and treatment dose need to be further defined.
Keywords: Hepatocellular carcinoma; Outcome
Thursday, July 27, 2006 12:30 PM
Poster Session: Malignancy (12:30 PM-2:00 PM)