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Updated: Aug 5, 2026
Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy
Published on: May 8, 2018
Clinical Outcomes of Stereotactic Body Radiotherapy in Hepatocellular Carcinoma Patients With Child-Turcotte-Pugh B
Divya Khosla1, Aarti Jamwal1, Rakesh Kapoor1
1Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India.
Objective:
Stereotactic body radiotherapy (SBRT) has emerged as a noninvasive local treatment option for patients who are not candidates for surgical resection or locoregional therapies; however, data on its safety and efficacy in patients with Child-Turcotte-Pugh (CTP) B liver dysfunction are limited. The primary aim of this study was to evaluate the safety and efficacy of SBRT in HCC patients with CTP-B liver dysfunction. Secondary objectives included the assessment of survival outcomes.
Methods:
This study included 31 patients with CTP-B HCC treated with SBRT from January 2022 to May 2025. HCC diagnosis was established by histopathology or imaging as per the American Association for the Study of Liver Diseases (AASLD) criteria and staged according to Barcelona Clinic Liver Cancer (BCLC) classification. Local control (LC) and survival outcomes were analyzed using the Kaplan-Meier method, and treatment-related toxicity was graded according to the CTCAE criteria.
Results:
The median age was 64 years, and 96.8% of patients were male. At baseline, most patients had moderate liver dysfunction [CTP-B 7: 18 (58%); 8: 8 (25.8%); 9: 5 (16.2%)]. All patients had cirrhosis, with viral hepatitis (hepatitis B virus [HBV]: 12.9%, hepatitis C virus [HCV]: 32.3%), alcohol-associated liver disease (ALD): 32.3%, and presumed MASLD-related cirrhosis (45.2%) as underlying etiologies. The median follow-up was 26 months (95% confidence interval [CI:: 25.17-31.28 months). SBRT doses ranged from 30 to 40 Gy in 5-6 fractions, with a median dose of 35 Gy. The 1- and 2-year LC rates were 96% and 50%, with an objective response rate of 67.7%. Median overall survival (OS) and progression-free survival were 14 and 9 months. Baseline albumin-bilirubin (ALBI) grade demonstrated a significant association with LC(P = 0.001), while baseline CTP-B score was associated with OS (P < 0.001). Treatment was well tolerated, with no grade ≥3 toxicities.
Conclusion:
SBRT may be a feasible treatment option for selected patients with HCC with CTP-B liver dysfunction, with encouraging LC and acceptable toxicity when delivered with careful patient selection and meticulous treatment planning.
