Key words: stereotactic body radia-
tion therapy, huge hepatocellular car-
Correspondence to: Mi-Sook Kim,
MD, Department of Radiation Oncolo-
gy, Korea Cancer Center Hospital, Ko-
rea Institute of Radiological and Med-
ical Sciences, 215-4 Gongneung-
dong, Nowon-gu, Seoul 139-706, Re-
public of Korea.
Received March 31, 2009;
accepted June 30, 2009.
Pilot study of stereotactic body radiotherapy
for huge hepatocellular carcinoma unsuitable
for other therapies
Young-Joo Shin1, Mi-Sook Kim1, Seong Yul Yoo1, Chul Koo Cho1,
Young Seok Seo1, Jin-kyu Kang1, Su Cheol Park2, Chul Ju Han2,
Sang Beom Kim3, Byong Hee Lee4, and Dong Han Lee5
1Department of Radiation Oncology,2Department of Internal Medicine,3Department of Surgery,
4Department of Radiology, and5Cyberknife Center, Korea Cancer Center Hospital, Korea Institute
of Radiological and Medical Sciences, Seoul, Korea
Aims. To determine the feasibility and efficacy of stereotactic body radiotherapy
(SBRT) for huge hepatocellular carcinoma unsuitable for other therapies.
Methods. Six patients with very large hepatocellular carcinomas (>10 cm) unsuitable
for surgical resection or that failed to respond to transcatheter arterial chemoem-
bolization (TACE) were treated by SBRT. Doses ranged from 32 Gy to 40 Gy in four
fractions. Survival, response, and toxicities were evaluated.
Results. After a median follow-up of 25.9 months (range 8.1-56 months), three pa-
tients had died and three were alive. Overall, treatment was well tolerated and no
dose-limiting toxicity or radiation-induced liver disease was observed. The median
survival was 10 months (range 3-56 months) and the median progression-free dura-
tion was 6 months (range, 2-21 months). Partial response was achieved by four pa-
tients, stable disease by one, and one patient had disease progression. One patient
with a partial response who underwent lobectomy after SBRT was alive 56 months
Conclusion. This study suggests that SBRT can be delivered safely at 32-40 Gy in four
other modalities such as surgery orTACE might prolong survival. Free full text avail-
able at www.tumorionline.it
Hepatocellular carcinoma (HCC) is the third most common cause of cancer death1.
In patients with a small HCC, hepatic resection and nonsurgical treatment modalities
have contributed to good survival. However, the treatment of patients with a HCC of
10 cm or larger in diameter (so-called huge HCC) is a challenge. Hepatic resection ap-
pears to be the most reasonable treatment for huge HCC, but the resection of such
large tumors is technically difficult and usually requires major hepatic resection,
which is associated with a higher operative mortality risk2,3. In patients with inopera-
ble huge HCC, transcatheter arterial chemoembolization (TACE) is considered a sec-
ond choice, but response rates are generally poor for large tumors and the 5-year sur-
vival rate is less than 10%4. Furthermore, after failure of TACE no standard treatment
is available, and various nonsurgical treatments such as hormonal therapy, im-
munotherapy, systemic and intra-arterial chemotherapy have been assessed in pilot
trials, but to date survival benefits have been marginal.
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(SBRT) for the treatment of liver tumors. In the majority of these studies, SBRT has been
shown to achieve a high rate of local control with low toxicity5-7. However, previous re-
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70 Y-J SHIN, M-S KIM, S-YYOO ET AL