Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma

Purpose To report outcomes of a phase I study of individualized stereotactic body radiotherapy treatment ( SBRT) for unresectable hepatocellular carcinoma ( HCC) and intrahepatic cholangiocarcinoma ( IHC). Patients and Methods Patients with unresectable HCC or IHC, and who are not suitable for standard therapies, were eligible for six-fraction SBRT during 2 weeks. Radiation dose was dependent on the volume of liver irradiated and the estimated risk of liver toxicity based on a normal tissue complication model. Toxicity risk was escalated from 5% to 10% and 20%, within three liver volume-irradiated strata, provided at least three patients were without toxicity at 3 months after SBRT. Results Forty-one patients with unresectable Child-Pugh A HCC ( n = 31) or IHC ( n = 10) completed six-fraction SBRT. Five patients ( 12%) had grade 3 liver enzymes at baseline. The median tumor size was 173 mL ( 9 to 1,913 mL). The median dose was 36.0 Gy ( 24.0 to 54.0 Gy). No radiation-induced liver disease or treatment-related grade 4/5 toxicity was seen within 3 months after SBRT. Grade 3 liver enzymes were seen in five patients ( 12%). Two patients ( 5%) with IHC developed transient biliary obstruction after the first few fractions. Seven patients ( five HCC, two IHC) had decline in liver function from Child-Pugh class A to B within 3 months after SBRT. Median survival of HCC and IHC patients was 11.7 months ( 95% CI, 9.2 to 21.6 months) and 15.0 months ( 95% CI, 6.5 to 29.0 months), respectively. Conclusion Individualized six-fraction SBRT is a safe treatment for unresectable HCC and IHC.