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Stereotactic Ablative Body Radiation Therapy for Previously Untreated Solitary Hepatocellular Carcinoma in Patients With Liver Disease
S320
International Journal of Radiation Oncology Biology Physics
often not be appropriate. SBRT offers an effective treatment modality for these patients. Caution should be exercised in treating patients with poor background liver function, which could further deteriorate. Author Disclosure: A. Mahadevan: F. Honoraria; Educational Presentations. M. Curry: None. B. Lake-Bakaar: None. A. Evenson: None. A. Bullock: None. E. Buchbinder: None. R. Miksad: None.
Purpose/Objective(s): The 90Y microsphere radioembolization is a treatment option for selected patients with primary or metastatic hepatic malignancy. Recently, the weak positron emission decay route of 90Y has been proposed to assess post-treatment deposition in tumor with high spatial resolution using PET imaging. We evaluated the feasibility of PET/ MRI following radioembolization for detecting in-vivo biodistribution of 90Y microspheres. Materials/Methods: PET/MRI was performed within 48 hours of 90Y radioembolization for 3 patients with hepatocellular carcinoma and 5 patients with metastatic disease (4 colorectal, 1 breast). Microsphere type included both resin (n Z 6) and glass (n Z 2). Biodistribution was qualitatively assessed as discrete within the tumor or ill-defined. Colocalization was evaluated by comparing the post-procedure PET uptake with the pre-procedure SPECT, as well as the post-procedure MRI for tumor localization. Results: PET/MRI demonstrated intrahepatic 90Y microsphere distribution in all patients following radioembolization (n Z 8). The administered activity was >90% of prescription for 7/8 patients (range, 0.7-1.62 GBq), while 1 patient was treated to stasis. PET biodistribution was discrete within tumor for 6 patients (3 hepatocellular carcinoma, 3 metastatic disease) and ill-defined for 2 patients. Co-localization between the pre-procedure SPECT and post-procedure PET was confirmed for all patients, but considered borderline for 4/8 patients, including 2 patients where limited concordance was observed in areas treated previously with radiofrequency ablation. Co-localization between the post-procedure PET and MRI was observed for 5/8 patients based on T1-weighted imaging (TRA VIBE) and 8/8 patients based on diffusion-weighted imaging. Conclusions: PET/MRI is feasible for evaluation of 90Y microsphere localization following radioembolization for both primary and metastatic hepatic disease. Functional imaging using diffusion-weighted MRI may provide an additional parameter to confirm PET biodistribution in areas of diffusion-restricted viable tumor. Future work will include quantitative in-vivo dosimetric evaluation, long-term adverse event surveillance, and clinical outcome measurements to identify whether this method may be useful to guide the management of patients with hepatic malignancy. Author Disclosure: C.K. Speirs: None. A. Benegal: None. K.J. Fowler: None. J.R. Olsen: None. N. Saad: None. A. Sharma: None. J. GarciaRamirez: None. R. Laforest: None. P.J. Parikh: None.
2306 Clinical Outcomes of Stereotactic Body Radiation Therapy for Primary or Recurrent Hepatocellular Carcinoma S. Yoon, J. Jung, Y. Lim, J. Shim, K. Kim, H. Lee, S. Kim, J. Park, and J. Kim; University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of Korea Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) has been an emerging non-invasive local treatment option for patients with hepatocellular carcinoma (HCC) when established curative treatment modalities cannot be applied. In the present study, we report our clinical experiences regarding to SBRT for small, unresectable HCC and evaluate the efficacy and clinical outcomes of this highly sophisticated treatment modality. Materials/Methods: A registry database of 165 patients (178 lesions) treated with SBRT for primary or recurrent HCC between March 2007 and December 2011 were analyzed retrospectively. All patients were immobilized and four-dimensional computed tomography (CT) scanning was done with free breathing. A dose of 10-20 Gy (median, 15 Gy) per fraction was given over 3-4 consecutive days to a total dose of 30-60 Gy (median, 45 Gy). The tumor response was determined by CT or magnetic resonance images performed 3 months after completion of SBRT according to the Response Evaluation Criteria in Solid Tumors criteria. The probability of cumulative survival was calculated according to the Kaplan-Meier method and compared statistically using log-rank test. Univariate and multivariate analysis were performed using a Cox proportional hazards models. Results: The median follow-up was 25.3 months (range, 1.8-68.6 months). We found that 33.1% of patients achieved a complete response and 34.3% achieved a partial response. Cumulative incidence of local recurrence rates at 3 years was 9.4%. Overall survival (OS) and intrahepatic progressionfree survival (IHPFS) rates at 3 years were 59.0% and 22.3%, respectively. The incidence of local recurrence was significantly related with viable tumor size (tumor size <3 cm vs 3 cm: 5.2% vs 28.3% at 3 years, p < 0.001). However, total dose did not affect the incidence of local recurrence. Multivariate analysis revealed that performance status, viable tumor size, and number of prior locoregional treatments were independent predictors of OS. Number of prior locoregional treatments was also independent prognostic factor in predicting IHPFS. Conclusions: SBRT for small HCC appears to be an effective noninvasive treatment modality for the local management of this tumor. These results suggested that SBRT can be a good alternative modality for the treatment of small HCCs that are unsuitable for surgical resection or local ablative therapy. To determine the accurate efficacy and impact on patients’ survival, well-designed prospective investigations are needed. Author Disclosure: S. Yoon: None. J. Jung: None. Y. Lim: None. J. Shim: None. K. Kim: None. H. Lee: None. S. Kim: None. J. Park: None. J. Kim: None.
2307 90Y Microsphere Hepatic Distribution Can Be Evaluated Following Radioembolization With PET/MRI C.K. Speirs,1 A. Benegal,1 K.J. Fowler,2 J.R. Olsen,1 N. Saad,2 A. Sharma,2 J. Garcia-Ramirez,1 R. Laforest,3 and P.J. Parikh1; 1Siteman Cancer Center, Barnes Jewish Hospital, St. Louis, MO, 2Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, 3Division of Radiological Sciences, Washington University, St. Louis, MO
2308 Stereotactic Ablative Body Radiation Therapy for Previously Untreated Solitary Hepatocellular Carcinoma in Patients With Liver Disease A. Takeda; Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan Purpose/Objective(s): We retrospectively evaluated outcomes of stereotactic ablative body radiation therapy (SABR) for previously untreated solitary hepatocellular carcinoma (us-HCC) unfit for ablation therapy and resection in patients with underlying liver disease. Materials/Methods: Between 2005 and 2012, 237 patients with HCC were treated with SABR with curative intent. Among them, patients with us-HCC, treated with only SABR or SABR preceded by transarterial chemoembolization (TACE) within 3 months and with a potential follow-up >6 months were eligible. Based on baseline liver function and irradiated liver volume and dose, 35-40 Gy in 5 fractions was prescribed to the 70-80% isodose line of the maximum dose covering the planning target volume. Treatment outcome and toxicities were analyzed. Results: Sixty-three patients were eligible, with a median follow-up duration of 24.4 months (range; 3.3-79.4 months). Twenty patients were treated with only SABR. In 43 patients treated with SABR preceded by TACE, accumulation of lipiodol in the tumor remained full in 5, was more than half with a partial defect in 16, was less than half in 17 and did not occur in 5 on pre-SABR evaluation CT. The 1-, 2- and 3-year local control rates were 100%, 97.1% and 93.0%, respectively. The intrahepatic
Volume 87 Number 2S Supplement 2013 recurrence-free rates were 80.1%, 57.6% and 31.3%, respectively. The overall survival rates were 100%, 93.4% and 81.5%, respectively. Grade 3 laboratory toxicities were observed in 18 patients and ascites occurred in one patient. Conclusions: Local control and overall survival after SABR for us-HCC were excellent despite the candidates being unfit for resection and ablation therapy. SABR is safe and might be an alternative to resection and ablation therapy. Further prospective studies are warranted to validate the effect of SABR for HCC. Author Disclosure: A. Takeda: None.
2309 Comparison Between Stereotactic Body Radiation Therapy for Liver Metastases and Hepatocellular Carcinoma H. Yamashita,1 O. Hiroshi,2 M. Yasuo,3 M. Naoya,4 M. Yukinori,5 N. Takuma,6 K. Tomoki,7 S. Shino,1 O. Mami,1 and N. Keiichi1; 1 University of Tokyo Hospital, Hongo, Japan, 2Yamanashi University, Yamanashi, Japan, 3Niigata University School of Medicine, Niigata, Japan, 4National Cancer Center Hospital, Tokyo, Japan, 5Kyoto University Graduate School of Medicine, Kyoto-shi, Japan, 6Yamagata University Hospital, Yamagata City, Japan, 7Hiroshima University, Hiroshima, Japan Purpose/Objective(s): The purpose of the study is to compare the clinical results of stereotactic body radiation therapy (SBRT) for liver metastases and for hepatocellular carcinoma (HCC) in a Japanese multi-institutional large database of SBRT. Materials/Methods: This is a retrospective study to review 81 patients with primary or metastatic liver cancers treated at 20 institutions extracted from the database of Japanese Radiological Society multiinstitutional SBRT study group (JRS-SBRTSG). The investigation period was from May 2004 to November 2012. HCC included 81 cases (HCC group) and the liver metastases included 63 cases (META group). The Child-Pugh score before SBRT for HCC group was 83% in grade A, 17% in grade B, and 1% in grade C. About the primary tumor site of liver metastases, colo-rectum was 63%, lung was 10%, and stomach was 10%. The number of SRT lesions was from 1 to 4 (solitary was 52/62 cases) for META group. Results: The mode value of RT total dose was 48 Gy in 4Fr (range; 40 Gy/4Fr - 60 Gy/10Fr) for HCC group and 52 Gy/4Fr (30 Gy/3Fr - 64 Gy/8Fr) for META group. The biological effective dose (a/b Z 10 Gy) was 75-105.6 Gy for HCC group. As to the initial local effect, CR and PR were 42% and 35% for HCC group and 14% and 71% for META group, respectively. At the last follow-up, alive was 68% and dead was 32% for HCC group. The cumulative local control rate of HCC group was 61.9% (+/- 6.9%) at 18 months and 59.1% (+/- 7.2%) at 24 months. Conclusions: The liver SBRT for metastatic liver tumor was inferior to for primary liver tumor. Author Disclosure: H. Yamashita: None. O. Hiroshi: None. M. Yasuo: None. M. Naoya: None. M. Yukinori: None. N. Takuma: None. K. Tomoki: None. S. Shino: None. O. Mami: None. N. Keiichi: None.
2310 Stereotactic Ablative Body Radiation Therapy for Small Hepatocellular Carcinoma: Outcomes in 185 Patients N. Sanuki; Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan Purpose/Objective(s): To evaluate outcomes in hepatocellular carcinoma (HCC) patients treated with two dose levels of stereotactic ablative body radiation therapy (SABR). Materials/ Methods: Between 2004 and 2012, 237 tumors in 221 HCC patients were treated with SABR. Patients followed-up 6 months were eligible. The prescription dose depended on liver function and liver dose: 40 Gy for Child-Pugh Classification (CPC)-A; 35 Gy for CPC-B, in 5 fractions, requiring a 5-Gy dose reduction if the liver
Poster Viewing Abstracts S321 receiving 20 Gy exceeded 20%. Treatment outcome and feasibility were analyzed. Results: One hundred eighty-five patients (n Z 48, the 35-Gy group; n Z 137, the 40-Gy group) were eligible, with a median follow-up duration of 24.2 months (range, 2.8-80.4 months). The 3-year overall survival and local control rates were 70.0% and 91.3%, respectively. There were no significant differences between the dose levels: the 3-year local control and overall survival rates in the 35-Gy and 40-Gy groups were 90.7% and 89.0% (log-rank p Z 0.99) and 66.0% and 72.1% (p Z 0.54), respectively. Acute Grade 3 toxicities were observed in 18 (9.7%). All but 3 (1.6%) were transient and promptly recovered to grade 1-2. Conclusions: SABR for HCC were safe and provided excellent outcomes either in 35 or 40 Gy / 5 fractions. Author Disclosure: N. Sanuki: None.
2311 Long-term Survival in Patients With Hepatocellular Carcinoma Initially Treated With Definitive Proton Beam Therapy T. Okumura,1 K. Fukuda,2 T. Hashimoto,1 M. Mizumoto,1 H. Ishikawa,1 T. Sakae,1 M. Abei,2 K. Tsuboi,1 and H. Sakurai1; 1Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan, 2Department of Gastroenterology, University of Tsukuba, Tsukuba, Japan Purpose/Objective(s): To evaluate the efficacy of proton beam therapy as definitive treatment for localized hepatocellular carcinoma. Materials /Methods: Between June 1992 and December 2005, one hundred fourteen patients with localized hepatocellular carcinoma were initially treated with proton beam therapy (PBT) alone. Ninety-six patients (84%) had hepatitis virus infection. The diameter of the tumor ranged from 10 to 135 mm (median: 41.2 mm). Nine patients had portal vein tumor thrombus (Vp2/ 3/ 4 Z 3/ 2/ 4). Basically, three treatment protocols (66 GyE in 10 fractions; 72.6 GyE in 22 fractions; 77 GyE in 35 fractions) were applied, depending on tumor location. Results: After median follow-up period of 37.3 months (2.3 to 155.3 months), 61 patients were alive and 53 were dead. Overall survival rate (OS) for all the patients was 75.9% at 3 years and 48.5% at 5 years. OS at 3 years by liver function were 82.7%, 70.8%, and 25% for Child A, B, and C cases, respectively. Progression-free survival was 42.3% at 3 years for all the patients, although local progression was observed in 10.3% of the treated tumor. Treatment related morbidity was minimal. Conclusions: These results suggest PBT can play a role of definitive treatment of patients with localized hepatocellular carcinoma. Author Disclosure: T. Okumura: None. K. Fukuda: None. T. Hashimoto: None. M. Mizumoto: None. H. Ishikawa: None. T. Sakae: None. M. Abei: None. K. Tsuboi: None. H. Sakurai: None.
2312 Treatment Outcome of Hepatic Re-irradiation in Patients With HCC S. Seol,1 H. Park,1 D. Lim,1 D. Oh,1 J. Noh,1 and S. Paik2; 1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of Korea, 2Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of Korea Purpose/Objective(s): We evaluated the efficacy and toxicity of repeated high dose 3-dimensional conformal radiation therapy (3D-CRT) for patients with unresectable hepatocellular carcinoma (HCC), which was not eligible for further local treatment modalities. Materials/Methods: Between 1998 and 2011, 45 patients received hepatic re-irradiation with high dose 3D-CRT. After excluding two ineligible patients, radiation therapy (RT) and medical records of the eligible 43 patients were retrospectively reviewed. The median age was 59 years (range, 29 to 71 years). There were 7 (16%) patients with Child-Pugh class B and 24 (56%) patients with vascular invasion. RT was delivered with palliative (n Z 24) or salvage (n Z 19) intent, and equivalent dose in 2 Gy fractions for a/b Z 10 Gy (EQD10/2) ranged from 31.25 Gy10/2 to 93.75
International Journal of Radiation Oncology Biology Physics
often not be appropriate. SBRT offers an effective treatment modality for these patients. Caution should be exercised in treating patients with poor background liver function, which could further deteriorate. Author Disclosure: A. Mahadevan: F. Honoraria; Educational Presentations. M. Curry: None. B. Lake-Bakaar: None. A. Evenson: None. A. Bullock: None. E. Buchbinder: None. R. Miksad: None.
Purpose/Objective(s): The 90Y microsphere radioembolization is a treatment option for selected patients with primary or metastatic hepatic malignancy. Recently, the weak positron emission decay route of 90Y has been proposed to assess post-treatment deposition in tumor with high spatial resolution using PET imaging. We evaluated the feasibility of PET/ MRI following radioembolization for detecting in-vivo biodistribution of 90Y microspheres. Materials/Methods: PET/MRI was performed within 48 hours of 90Y radioembolization for 3 patients with hepatocellular carcinoma and 5 patients with metastatic disease (4 colorectal, 1 breast). Microsphere type included both resin (n Z 6) and glass (n Z 2). Biodistribution was qualitatively assessed as discrete within the tumor or ill-defined. Colocalization was evaluated by comparing the post-procedure PET uptake with the pre-procedure SPECT, as well as the post-procedure MRI for tumor localization. Results: PET/MRI demonstrated intrahepatic 90Y microsphere distribution in all patients following radioembolization (n Z 8). The administered activity was >90% of prescription for 7/8 patients (range, 0.7-1.62 GBq), while 1 patient was treated to stasis. PET biodistribution was discrete within tumor for 6 patients (3 hepatocellular carcinoma, 3 metastatic disease) and ill-defined for 2 patients. Co-localization between the pre-procedure SPECT and post-procedure PET was confirmed for all patients, but considered borderline for 4/8 patients, including 2 patients where limited concordance was observed in areas treated previously with radiofrequency ablation. Co-localization between the post-procedure PET and MRI was observed for 5/8 patients based on T1-weighted imaging (TRA VIBE) and 8/8 patients based on diffusion-weighted imaging. Conclusions: PET/MRI is feasible for evaluation of 90Y microsphere localization following radioembolization for both primary and metastatic hepatic disease. Functional imaging using diffusion-weighted MRI may provide an additional parameter to confirm PET biodistribution in areas of diffusion-restricted viable tumor. Future work will include quantitative in-vivo dosimetric evaluation, long-term adverse event surveillance, and clinical outcome measurements to identify whether this method may be useful to guide the management of patients with hepatic malignancy. Author Disclosure: C.K. Speirs: None. A. Benegal: None. K.J. Fowler: None. J.R. Olsen: None. N. Saad: None. A. Sharma: None. J. GarciaRamirez: None. R. Laforest: None. P.J. Parikh: None.
2306 Clinical Outcomes of Stereotactic Body Radiation Therapy for Primary or Recurrent Hepatocellular Carcinoma S. Yoon, J. Jung, Y. Lim, J. Shim, K. Kim, H. Lee, S. Kim, J. Park, and J. Kim; University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of Korea Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) has been an emerging non-invasive local treatment option for patients with hepatocellular carcinoma (HCC) when established curative treatment modalities cannot be applied. In the present study, we report our clinical experiences regarding to SBRT for small, unresectable HCC and evaluate the efficacy and clinical outcomes of this highly sophisticated treatment modality. Materials/Methods: A registry database of 165 patients (178 lesions) treated with SBRT for primary or recurrent HCC between March 2007 and December 2011 were analyzed retrospectively. All patients were immobilized and four-dimensional computed tomography (CT) scanning was done with free breathing. A dose of 10-20 Gy (median, 15 Gy) per fraction was given over 3-4 consecutive days to a total dose of 30-60 Gy (median, 45 Gy). The tumor response was determined by CT or magnetic resonance images performed 3 months after completion of SBRT according to the Response Evaluation Criteria in Solid Tumors criteria. The probability of cumulative survival was calculated according to the Kaplan-Meier method and compared statistically using log-rank test. Univariate and multivariate analysis were performed using a Cox proportional hazards models. Results: The median follow-up was 25.3 months (range, 1.8-68.6 months). We found that 33.1% of patients achieved a complete response and 34.3% achieved a partial response. Cumulative incidence of local recurrence rates at 3 years was 9.4%. Overall survival (OS) and intrahepatic progressionfree survival (IHPFS) rates at 3 years were 59.0% and 22.3%, respectively. The incidence of local recurrence was significantly related with viable tumor size (tumor size <3 cm vs 3 cm: 5.2% vs 28.3% at 3 years, p < 0.001). However, total dose did not affect the incidence of local recurrence. Multivariate analysis revealed that performance status, viable tumor size, and number of prior locoregional treatments were independent predictors of OS. Number of prior locoregional treatments was also independent prognostic factor in predicting IHPFS. Conclusions: SBRT for small HCC appears to be an effective noninvasive treatment modality for the local management of this tumor. These results suggested that SBRT can be a good alternative modality for the treatment of small HCCs that are unsuitable for surgical resection or local ablative therapy. To determine the accurate efficacy and impact on patients’ survival, well-designed prospective investigations are needed. Author Disclosure: S. Yoon: None. J. Jung: None. Y. Lim: None. J. Shim: None. K. Kim: None. H. Lee: None. S. Kim: None. J. Park: None. J. Kim: None.
2307 90Y Microsphere Hepatic Distribution Can Be Evaluated Following Radioembolization With PET/MRI C.K. Speirs,1 A. Benegal,1 K.J. Fowler,2 J.R. Olsen,1 N. Saad,2 A. Sharma,2 J. Garcia-Ramirez,1 R. Laforest,3 and P.J. Parikh1; 1Siteman Cancer Center, Barnes Jewish Hospital, St. Louis, MO, 2Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, 3Division of Radiological Sciences, Washington University, St. Louis, MO
2308 Stereotactic Ablative Body Radiation Therapy for Previously Untreated Solitary Hepatocellular Carcinoma in Patients With Liver Disease A. Takeda; Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan Purpose/Objective(s): We retrospectively evaluated outcomes of stereotactic ablative body radiation therapy (SABR) for previously untreated solitary hepatocellular carcinoma (us-HCC) unfit for ablation therapy and resection in patients with underlying liver disease. Materials/Methods: Between 2005 and 2012, 237 patients with HCC were treated with SABR with curative intent. Among them, patients with us-HCC, treated with only SABR or SABR preceded by transarterial chemoembolization (TACE) within 3 months and with a potential follow-up >6 months were eligible. Based on baseline liver function and irradiated liver volume and dose, 35-40 Gy in 5 fractions was prescribed to the 70-80% isodose line of the maximum dose covering the planning target volume. Treatment outcome and toxicities were analyzed. Results: Sixty-three patients were eligible, with a median follow-up duration of 24.4 months (range; 3.3-79.4 months). Twenty patients were treated with only SABR. In 43 patients treated with SABR preceded by TACE, accumulation of lipiodol in the tumor remained full in 5, was more than half with a partial defect in 16, was less than half in 17 and did not occur in 5 on pre-SABR evaluation CT. The 1-, 2- and 3-year local control rates were 100%, 97.1% and 93.0%, respectively. The intrahepatic
Volume 87 Number 2S Supplement 2013 recurrence-free rates were 80.1%, 57.6% and 31.3%, respectively. The overall survival rates were 100%, 93.4% and 81.5%, respectively. Grade 3 laboratory toxicities were observed in 18 patients and ascites occurred in one patient. Conclusions: Local control and overall survival after SABR for us-HCC were excellent despite the candidates being unfit for resection and ablation therapy. SABR is safe and might be an alternative to resection and ablation therapy. Further prospective studies are warranted to validate the effect of SABR for HCC. Author Disclosure: A. Takeda: None.
2309 Comparison Between Stereotactic Body Radiation Therapy for Liver Metastases and Hepatocellular Carcinoma H. Yamashita,1 O. Hiroshi,2 M. Yasuo,3 M. Naoya,4 M. Yukinori,5 N. Takuma,6 K. Tomoki,7 S. Shino,1 O. Mami,1 and N. Keiichi1; 1 University of Tokyo Hospital, Hongo, Japan, 2Yamanashi University, Yamanashi, Japan, 3Niigata University School of Medicine, Niigata, Japan, 4National Cancer Center Hospital, Tokyo, Japan, 5Kyoto University Graduate School of Medicine, Kyoto-shi, Japan, 6Yamagata University Hospital, Yamagata City, Japan, 7Hiroshima University, Hiroshima, Japan Purpose/Objective(s): The purpose of the study is to compare the clinical results of stereotactic body radiation therapy (SBRT) for liver metastases and for hepatocellular carcinoma (HCC) in a Japanese multi-institutional large database of SBRT. Materials/Methods: This is a retrospective study to review 81 patients with primary or metastatic liver cancers treated at 20 institutions extracted from the database of Japanese Radiological Society multiinstitutional SBRT study group (JRS-SBRTSG). The investigation period was from May 2004 to November 2012. HCC included 81 cases (HCC group) and the liver metastases included 63 cases (META group). The Child-Pugh score before SBRT for HCC group was 83% in grade A, 17% in grade B, and 1% in grade C. About the primary tumor site of liver metastases, colo-rectum was 63%, lung was 10%, and stomach was 10%. The number of SRT lesions was from 1 to 4 (solitary was 52/62 cases) for META group. Results: The mode value of RT total dose was 48 Gy in 4Fr (range; 40 Gy/4Fr - 60 Gy/10Fr) for HCC group and 52 Gy/4Fr (30 Gy/3Fr - 64 Gy/8Fr) for META group. The biological effective dose (a/b Z 10 Gy) was 75-105.6 Gy for HCC group. As to the initial local effect, CR and PR were 42% and 35% for HCC group and 14% and 71% for META group, respectively. At the last follow-up, alive was 68% and dead was 32% for HCC group. The cumulative local control rate of HCC group was 61.9% (+/- 6.9%) at 18 months and 59.1% (+/- 7.2%) at 24 months. Conclusions: The liver SBRT for metastatic liver tumor was inferior to for primary liver tumor. Author Disclosure: H. Yamashita: None. O. Hiroshi: None. M. Yasuo: None. M. Naoya: None. M. Yukinori: None. N. Takuma: None. K. Tomoki: None. S. Shino: None. O. Mami: None. N. Keiichi: None.
2310 Stereotactic Ablative Body Radiation Therapy for Small Hepatocellular Carcinoma: Outcomes in 185 Patients N. Sanuki; Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan Purpose/Objective(s): To evaluate outcomes in hepatocellular carcinoma (HCC) patients treated with two dose levels of stereotactic ablative body radiation therapy (SABR). Materials/ Methods: Between 2004 and 2012, 237 tumors in 221 HCC patients were treated with SABR. Patients followed-up 6 months were eligible. The prescription dose depended on liver function and liver dose: 40 Gy for Child-Pugh Classification (CPC)-A; 35 Gy for CPC-B, in 5 fractions, requiring a 5-Gy dose reduction if the liver
Poster Viewing Abstracts S321 receiving 20 Gy exceeded 20%. Treatment outcome and feasibility were analyzed. Results: One hundred eighty-five patients (n Z 48, the 35-Gy group; n Z 137, the 40-Gy group) were eligible, with a median follow-up duration of 24.2 months (range, 2.8-80.4 months). The 3-year overall survival and local control rates were 70.0% and 91.3%, respectively. There were no significant differences between the dose levels: the 3-year local control and overall survival rates in the 35-Gy and 40-Gy groups were 90.7% and 89.0% (log-rank p Z 0.99) and 66.0% and 72.1% (p Z 0.54), respectively. Acute Grade 3 toxicities were observed in 18 (9.7%). All but 3 (1.6%) were transient and promptly recovered to grade 1-2. Conclusions: SABR for HCC were safe and provided excellent outcomes either in 35 or 40 Gy / 5 fractions. Author Disclosure: N. Sanuki: None.
2311 Long-term Survival in Patients With Hepatocellular Carcinoma Initially Treated With Definitive Proton Beam Therapy T. Okumura,1 K. Fukuda,2 T. Hashimoto,1 M. Mizumoto,1 H. Ishikawa,1 T. Sakae,1 M. Abei,2 K. Tsuboi,1 and H. Sakurai1; 1Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan, 2Department of Gastroenterology, University of Tsukuba, Tsukuba, Japan Purpose/Objective(s): To evaluate the efficacy of proton beam therapy as definitive treatment for localized hepatocellular carcinoma. Materials /Methods: Between June 1992 and December 2005, one hundred fourteen patients with localized hepatocellular carcinoma were initially treated with proton beam therapy (PBT) alone. Ninety-six patients (84%) had hepatitis virus infection. The diameter of the tumor ranged from 10 to 135 mm (median: 41.2 mm). Nine patients had portal vein tumor thrombus (Vp2/ 3/ 4 Z 3/ 2/ 4). Basically, three treatment protocols (66 GyE in 10 fractions; 72.6 GyE in 22 fractions; 77 GyE in 35 fractions) were applied, depending on tumor location. Results: After median follow-up period of 37.3 months (2.3 to 155.3 months), 61 patients were alive and 53 were dead. Overall survival rate (OS) for all the patients was 75.9% at 3 years and 48.5% at 5 years. OS at 3 years by liver function were 82.7%, 70.8%, and 25% for Child A, B, and C cases, respectively. Progression-free survival was 42.3% at 3 years for all the patients, although local progression was observed in 10.3% of the treated tumor. Treatment related morbidity was minimal. Conclusions: These results suggest PBT can play a role of definitive treatment of patients with localized hepatocellular carcinoma. Author Disclosure: T. Okumura: None. K. Fukuda: None. T. Hashimoto: None. M. Mizumoto: None. H. Ishikawa: None. T. Sakae: None. M. Abei: None. K. Tsuboi: None. H. Sakurai: None.
2312 Treatment Outcome of Hepatic Re-irradiation in Patients With HCC S. Seol,1 H. Park,1 D. Lim,1 D. Oh,1 J. Noh,1 and S. Paik2; 1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of Korea, 2Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of Korea Purpose/Objective(s): We evaluated the efficacy and toxicity of repeated high dose 3-dimensional conformal radiation therapy (3D-CRT) for patients with unresectable hepatocellular carcinoma (HCC), which was not eligible for further local treatment modalities. Materials/Methods: Between 1998 and 2011, 45 patients received hepatic re-irradiation with high dose 3D-CRT. After excluding two ineligible patients, radiation therapy (RT) and medical records of the eligible 43 patients were retrospectively reviewed. The median age was 59 years (range, 29 to 71 years). There were 7 (16%) patients with Child-Pugh class B and 24 (56%) patients with vascular invasion. RT was delivered with palliative (n Z 24) or salvage (n Z 19) intent, and equivalent dose in 2 Gy fractions for a/b Z 10 Gy (EQD10/2) ranged from 31.25 Gy10/2 to 93.75