Utility-Based Dose Selection for Stereotactic Body Radiation Therapy in Hepatocellular Carcinoma

Area of Science:

• Radiation Oncology
• Hepatocellular Carcinoma Research
• Medical Physics

Background:

• Stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) often involves implicit trade-offs between treatment efficacy and toxicity.
• Optimizing SBRT dose selection requires a quantitative approach to balance these competing factors.

Purpose of the Study:

• To develop and evaluate a utility-based approach for quantitative dose selection in SBRT for HCC.
• To compare the predicted clinical outcomes and overall utility of this novel approach against standard dosing protocols.

Main Methods:

• Developed predictive models for local progression, competing mortality, and liver toxicity using a multi-institutional SBRT patient cohort.
• Integrated individualized risks of progression and toxicity within a utility framework to quantify the efficacy/toxicity trade-off.
• Performed a simulation comparing utility-based dose selection with standard dosing (RTOG 1112).

Main Results:

• The optimal SBRT dose varied significantly based on patient liver function (Child-Pugh score).
• Optimal tumor biologically effective dose (BED10) ranged from 112 Gy10 for Child-Pugh A to 26 Gy10 for Child-Pugh C cirrhosis.
• Simulation results showed that utility gains depended on the weighting of toxicity versus tumor control.

Conclusions:

• A novel utility-based framework for SBRT dose selection in HCC has been developed.
• This approach quantitatively integrates individualized efficacy and toxicity predictions.
• The method holds promise for personalizing SBRT treatment planning in HCC.