Stereotactic body radiation therapy in patients with hepatocellular carcinoma: A mini-review

Table 1 Prospective trials and large ( > 100 patients) retrospective series evaluating stereotactic body radiation therapy in hepatocellular carcinoma

Author	Yr	Type	n	Size	VI	PVT	mf	PT	CP class	f/u	Dose	1y-LC	1y-OS
Méndez Romero et al[25]	2006	phase I/II	8 (11)	3.5 (0.5-7) cm	38%	25%	25%	NR	A: 63%, B: 25%, UK: 12%	13	25-37.5/3-5Fx	75%	75%
Tse et al[26]	2008	phase I	31 (NB)	173 (9-1913) mL	52%	NR	NR	61%	A: 100%	181	24-54/6Fx	65%1	48%
Cárdenes et al[27]	2010	phase I	17 (25)	34 (8-95) mL	NR	18%	30%	24%	A: 35%, B: 65%	24	36-48/3-5Fx	100%	75%
Kang et al[28]	2012	phase II	47 (56)	15 (2-214) mL	NR	29%	17%	100%2	A: 87%, B: 13%	17	42-60/3Fx	95%4	69%4
Price et al[29]	2012	phase I/II	26 (29)	NR (21-253) mL	NR	12%	12%	27%	A: 54%, B: 46%	13	36-48/3-5Fx	96%	77%
Huang et al[30]	2012	phase II	36 (NB)	4.8 (1.1-12.3) cm	NR	NR	NR	NR	A: 78%, B: 19%, C: 3%	14	25-48/4-5Fx	88%	64%4
Bujold et al[31]	2013	phase I/II	102 (NB)	117 (1-1913) mL	55%	NR	61%	52%	A: 100%	31	24-54/6Fx	87%	55%
Culleton et al[32]	2014	phase II	29 (NB)	9 (4-27) cm	NR	76%	NR	14%	B: 97%, C: 3%	NR	21-49/5-15Fx	NR	32%
Sanuki et al[33]	2014	retro	185 (185)	8 (1.6-65) mL	NR	NR	0%	68%2	A: 85%, B: 15%	23	35-40/5Fx	99%	95%
Lasley et al[14]	2015	phase I/II	59 (65)	34 (2-107) mL	NR	NR	NR	NR	A: 64%, B: 36%	33/463	36-48/3-5Fx	NR	91%/ 82%3
Scorsetti et al[34]	2015	phase II	43 (63)	5 (1-13) cm	NR	20%	43%	65%	A: 53%, B: 47%	8	36-75/3-6Fx	86%	78%
Su et al[35]	2016	retro	132 (175)	3 (1.1-5) cm	NR	NR	28%	30%	A: 86%, B: 14%	21	42-46/3-Fx	91%	94%
Takeda et al[36]	2016	phase II	90 (90)	NR (1-4) cm	NR	NR	0%	64%	A: 91%, B: 9%	42	35-40/5Fx	96%5	67%5
Moon et al[37]	2018	phase II	11 (NB)	23 (3-145) mL1	NR	NR	13%1	48%1	NR	131	27.5-45/3-5Fx	82%	36%
Nabavizadeh et al[38]	2018	retro	146 (146)	NR	NR	10%	0%	92%	A: 46%,B: 41%,C: 13%	23	50/5Fx6	97%	NR
Jeong et al[39]	2018	retro	119 (139)	1.7 (NR) cm	0%	0%	NR	97%	A: 91%, B: 9%	26	30-60/3Fx	99%	99%

¹All patients (including different histologies);

²TACE 1-2 mo prior to SBRT;

³Reported separately for CP-A and CP-B patients;

⁴2-year rate;

⁵3-year rate;

⁶Patients with poor liver function were treated with hypofractionated radiation therapy (45 Gy in 18 fractions).

n: Number of patients (lesions); cm: Cm diameter; mL: Milliliter volume; VI: Vascular invasion; PVT: Portal vein thrombosis; mf: Multifokal; PT: Prior treatment; CP: Child-Pugh; f/u: Median follow-up in months; dose: Total dose in Gy; Fx: Number of fractions; 1y-LC: 1-year local control rate; 1y-OS: 1-year overall survival rate; retro: Retrospective; UK: Unknown; NR: Not reported.

Table 2 Studies comparing stereotactic body radiation therapy to other local treatments

Author	Yr	Type	Treat.	n	Size	mf	PT	CP class	f/u	Dose	1y-LC	1y-OS	tox.	Comment
Su et al[40]	2017	pm	SBRT	33 (45)	3.3 (NR) cm	36%	0%	A: 100%	42	42-48/3Fx	84%1	100%	nausea4	LC/OS NS
			OP	33 (45)	3.3 (NR) cm	30%	0%	A: 100%	44		72%1	97%	bleed./pain5
Wahl et al[19]	2016	retro	SBRT	63 (83)	2.2 (0.1-10) cm	29%	2 (0-7)2	A: 69%, B: 29%, C: 2%	13	30-50/3-5Fx	97%	74%	grade3+:3%	LC/OS NS
			RFA	161 (249)	1.8 (0.6-7) cm	32%	0 (0-7)2	A: 50%, B: 42%, C: 8%	20		84%	70%	grade3+:11%	> 2 cm LC sig↑ with SBRT
Sapir et al[20]	2018	retro	SBRT	125 (173)	2.3 (0.1-20.8) cm	NR	2 (NR)2	6 (5-9)3	12	30-50/3-5Fx	97%	75%	grade3+:8%	LC sig↑ with SBRT
			TACE	84 (84)	2.9 (0.7-15) cm	NR	0 (NR)2	6 (5-9)3	23		47%	74%	grade3+:13%	Tox sig↑ with TACE

¹Intrahepatic recurrence free survival;

²Number of prior treatments median (range);

³CP score median (range);

⁴All grades, significantly increased with SBRT;

⁵All grades, significantly increaesd with surgery.

treat.: Treatment; n: Number of patients (lesions); size: Lesion size median(range); cm: Centimeter diameter; mf: Multifokal; PT: Prior treatment; CP: Child-Pugh; f/u: Median follow-up in months; dose: Total dose in Gy; Fx: Number of fractions; 1y-LC: 1-year local control rate; 1y-OS: 1-year overall survival rate; tox: Toxicity, NS: Not significant; pm: Propensity score matched pair analysis; retro: Retrospective; bleed.: bleeding; sig: Significant; OP: Surgery; RFA: Radiofrequency ablation; TACE: Transarterial chemoablation; NR: Not reported.