Headline: Liver stereotactic body radiation (SBRT) prolongs survival for patients with unresectable hepatocellular carcinoma (HCC) receiving sorafenib.
The Study: Did you know HCC is the third leading cause of cancer death in the world? RTOG 1112 is a unique prospective randomized trial in the space of very locally-advanced HCC. 177 patients receiving sorafenib were randomized to +/- the addition of SBRT. To be eligible, they could not be candidates for resection, transplant, TACE, or ablation. Now, liver SBRT can be complicated, especially with large volume disease. Here, enrollees could have as many as 5 tumors spanning as much as 20 cm, and three-quarters of patients had vascular invasion. On this trial, the prescription was delivered over 5 fractions ideally to 50 Gy but tailored down to as low as to 27.5 Gy as needed to spare adequate healthy liver. Alas, the bold primary endpoint of overall survival was significantly prolonged with the addition of SBRT (12.3 → 15.8 months). And that’s with 22% of those in the sorafenib alone arm receiving salvage SBRT upon progression. What’s more, with the graded dosing scheme here, grade 3+ toxicity was virtually identical across arms at 42-47%. A looming question is whether these outcomes would be the same with the new preferred first-line regimen atezolizumab and bevacizumab rather than sorafenib.
TBL: Liver SBRT dosed to spare an adequate amount of healthy liver may prolong survival in patients with advanced HCC who are not candidates for other forms of local therapy.
- Dawson, ASTRO 2022