Clinical study of stereotactic body radiotherapy for postoperative recurrence of hepatocellular carcinoma

PANG Jun; CHEN Haotao; CHEN Yan; YUAN Jin; Li Changqing

Abstract：Objective To investigate the effect and safety of stereotactic body radiotherapy ( SBRT) with body gamma-knife in patients with hepatocellular carcinoma ( HCC) of postoperative recurrence. Methods A total of 92 HCC patients with postoperative recurrence were treated with stereotactic body radiotherapy with super-gamma-knife ( type SGS-I ) . The volume of tumors was 4. 5-958. 3cm3. The total radiation dose was 35-44Gy, 3. 5-5. 5Gy/f (50%-80% isodose line), 7-12f, 5 days/week. The curative effect was analyzed by RECIST version 1. 1. The levels of alpha fetoprotein (AFP) and alanine aminotransferase (ALT) were measured before and after treatment. The patients were followed up for overall survival ( OS) and 1-, 3-, 5-year survival rates. The adverse reaction was evaluated by RTOG/EORTC criteria. Results A total of 92 patients could be evaluated, among whom 51 achieved CR, 36 PR and 5 SD with the response rate of 94. 6%. The level of AFP after treatment was (157. 93±93. 67)μg/L, lower than (846. 57±258. 39)μg/L before treatment with statistical difference (P<0. 05). The levels of ALT were (87. 73±21. 56) U/L and (53. 55±19. 33) U/L without significant difference ( P>0. 05) . The medium OS was 16. 0 months with the 1-, 3-, 5-year survival rates of 71. 6%, 31. 8% and 13. 0%, respectively. The main adverse reactions during treatment were bone marrow suppression, gastrointestinal reactions, fatigue and radiation induced liver injury, mainly in grade 1-2, and all could be releaved by symptomatic treatment. Conclusion SBRT with super-gamma-knife exerts a definite effect on HCC patients with postoperative recurrence with mild side effect.