Stereotactic body radiotherapy for hepatocellular carcinoma: Five-year prospective registry outcomes from an Australian tertiary transplant centre

Table 1 Patient characteristics at baseline, n (%)

Variable	n = 58
Median age (IQR)	66.5 (60-74)
Gender
Male	47 (81.03)
Female	11 (18.97)
ECOG
0	52 (89.66)
1	3 (5.17)
2+	3 (5.17)
Liver cirrhosis
No	4 (6.90)
Yes	54 (93.10)
Pre-existing liver disease
HBV	9 (15.52)
HCV	24 (41.38)
EtOH	19 (32.76)
MASLD	14 (24.14)
Other	2 (3.45)
Unsure/unknown	2 (3.45)
Nil	2 (3.45)
Child-Pugh status
5	20 (34.48)
6	23 (39.66)
7	5 (8.62)
8	6 (10.34)
ALBI
Grade 1	13 (22.41)
Grade 2	43 (74.14)
Grade 3	2 (3.45)
MELD
< 10	28 (48.28)
10-19	26 (44.83)
> 20	4 (6.90)

ECOG: Eastern Cooperative Oncology Group; HBV: Hepatitis B virus; HCV: Hepatitis C virus; EtOH: Alcohol-related liver disease; MASLD: Metabolic dysfunction-associated steatotic liver disease; ALBI: Albumin-bilirubin; MELD: Model for end-stage liver disease; IQR: Interquartile range.

Table 2 Tumour characteristics and stereotactic body radiotherapy parameters (n = 60 treatment courses), n (%)/interquartile range

Variable	n = 60
BCLC stage
Stage 0	10 (16.67)
Stage A	16 (26.67)
Stage B	24 (40.00)
Stage C	10 (16.67)
Vascular invasion	6 (10.00)
Reason for SBRT
First-line curative ablation	2 (3.33)
Salvage curative ablation	13 (21.67)
Bridge to liver transplant	13 (21.67)
Alternative to TACE/SIRT/sorafenib	7 (11.67)
In combination with TACE	15 (25.00)
Non-ablative treatment of recurrence after prior locoregional therapies	10 (16.67)
Prior HCC treatment
TACE	51 (85.00)
RFA/microwave	18 (30.00)
Resection	2 (3.33)
SIRT	2 (3.33)
Percutaneous ethanol injection	2 (3.33)
No prior treatment	6 (10.00)
Motion management
Exhale breath-hold	32 (53.33)
Inhale breath-hold	18 (30)
Free breathing	10 (16.67)
Dose fractionation
40 Gy in 5 fractions	27 (45.00)
30 Gy in 5 fractions	10 (16.70)
50 Gy in 5 fractions	5 (8.30)
40 Gy in 6 fractions	4 (6.45)
35 Gy in 5 fractions	4 (6.45)
Other schedules	10 (16.70)
Median BED10 prescription dose (Gy)	72 (53.25-72.00)
Maximum tumour diameter (mm)	24.5 (18-35)
GTV volume (cc)	4.83 (2.87-14.73)
PTV volume (cc)	21.82 (14.66-48.91)
PTV D95 (Gy)
First lesion	66.3 (49.00-73.40)
Second lesion (n = 4)	67.60 (58.96-72.82)
PTV Dmin
First lesion	61.42 (45.93-71.33)
Second lesion (n = 4)	68.47 (57.97-73.07)
PTV Dmax
First lesion	106.19 (76.21-112.58)
Second lesion (n = 4)	113.72 (109.67-130.09)
Liver-GTV (cc)	1560.9 (1156.80-2015.20)
Mean dose to liver-GTV (Gy)	4.56 (3.06-6.33)
Liver-GTV volume (cc) < 15 Gy	1146 (944-1431)
OAR limiting dose
Liver	9 (15.00)
Stomach/oesophagus	3 (5.00)
Small bowel	1(1.67)
Large bowel	1 (1.67)
Central bile ducts	9 (15.00)
Heart	7 (11.67)
Other (chest wall, IVC and duodenum)	10 (16.67)
Patient completed prescribed course	59 (98.33)

BCLC: Barcelona Clinic Liver Cancer; SBRT: Stereotactic body radiotherapy; TACE: Transarterial chemoembolisation; SIRT: Selective internal radiation therapy; RFA: Radiofrequency ablation; BED₁₀: Biologically effective dose; GTV: Gross tumour volume; PTV: Planning target volume; OAR: Organ at risk; IVC: Inferior vena cava.

Table 3 Treatment outcomes including local control, progression patterns, and survival, n (%)

Variable	n = 60
Median follow up (months)	23.6 (13.50-36.80)
Site of first relapse
Local failure	8 (13.33)
Distant intrahepatic disease	21 (35.00)
Extrahepatic disease	8 (13.33)
Subsequent treatment for intrahepatic relapse
TACE	6
SBRT	2
OLT	2
Other	6
Systemic therapy	12
Death	34 (56.67)
Cause of death
Cancer-related death	26
Non-cancer related	5
Liver failure	2
Unknown	1

TACE: Transarterial chemoembolisation; SBRT: Stereotactic body radiotherapy; OLT: Orthotopic liver transplantation.