Individualized adaptive stereotactic body radiation therapy (SBRT) based on liver biomarkers may be highly effective and safe without increasing relapse risk in patients with hepatocellular carcinoma who have had pre-existing liver dysfunction, according to a study published in JAMA Oncology.1

For this phase 2 study (ClinicalTrials.gov Identifier: NCT01522937), researchers enrolled 90 previously treated patients with intrahepatic cancer and measured indocyanine green retention at 15 minutes (ICGR15) to assess liver function. Three of the 5 planned SBRT treatments were then administered, and 4 weeks later ICGR15 was reassessed and results were used to adjust the final 2 doses of SBRT.

Sixty-two patients received all 5 fractions of SBRT, with 15 patients receiving dose-reduced fractions due to an above-threshold ICGR15 measurement at reassessment.

The 1-year control rate was 99% (95% CI, 97-100), the 2-year control rate was 95% (95% CI, 91-99), and the median time to progression was 9 months.

The overall survival at 1-year was 67% (95% CI, 58-78), and at 2 years was 36% (95% CI, 27-48).

Complications occurred at a lower rate than estimated, with 7% of patients experiencing a 2-point decline in Child-Pugh score 6 months after receiving SBRT.

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The authors concluded that “this strategy of individualized adaptive radiotherapy may represent a new treatment paradigm in which dose is based on individual, rather than population-based, tolerance to treatment.”

Reference

  1. Feng M, Suresh K, Schipper MJ, et al. Individualized adaptive stereotactic body radiotherapy for liver tumors in patients at high risk for liver damage. 2017 Aug 10. JAMA Oncol. doi: 10.1001/jamaoncol.2017.2303 [Epub ahead of print]