Abstract # 1072 Phase I Study Of Stereotactic Radiotherapy For Unresectable Hepatocellular Carcinoma And Intrahepatic Cholangiocarcinoma

Presenter: Dawson, Laura

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From August 2003 to March 2006, 47 heavily pre-treated
patients initiated SRT. Prior treatments included liver transplant, liver
resection, TACE, ablation and chemotherapy. Two patients discontinued treatment
early due to a variceal bleed and sepsis. 45 patients completed SRT (33 HCC, 12
CC). The median age was 66 years (41-85 years). The median tumor volume was 374
cc (3.8-1913 cc). At the time of SRT, 14 patients (31%) had extra-hepatic
disease, 17 patients with HCC (52%) had portal vein thrombosis and 1 had
intra-ductal disease. Underlying liver disease was common, due predominantly to
Hepatitis B (19), Hepatitis C (11) and alcoholic cirrhosis (4). The median
prescribed GTV PTV dose was 37.3 Gy (24 Gy-54 Gy). The median mean liver dose
was 17.5 Gy (1.5-25.2 Gy). No dose-limiting related grade 4/5 toxicity or
classic RILD was observed in 41 patients treated at levels I-III for the mid and
high Veff strata and in 4 patients treated with 54 Gy in 6 fractions at level I
for the low Veff strata. Grade 3 toxicity occurring < 3 months post SRT
consisted of: fatigue (1), transient liver enzyme increase (3) and ascites (6).
Liver Child-Pugh score declined to B in the 6 patients with ascites (4 with PD)
and 1 with fatigue (low albumin). A late tumor-duodenal fistula occurred 15
months following 36 Gy in 6 fractions to an extensive HCC. The objective
response rate was 57%: CR (4), PR (21), SD (12), PD
(7). The median time to maximal response was 4.3 months (max. 19.8 months). At
a median potential follow-up of 9.6 months, the median survival for CC and HCC
was 17.7 months (95% CI: 7.3, 25.3) and 8.8 months (95% CI: 3.9, 14.7)

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