Efficacy and safety of stereotactic body radiation therapy in elderly patients with cirrhosis and large advanced hepatocellular carcinoma

Objective:To evaluate the safety and efficacy of stereotactic body radiation therapy (SBRT) for 70 years or older patients with advanced hepatocellular carcinoma (aHCC). Materials and Methods:This observational retrospective study was done between May 2020 and March 2023. The data of 24 elderly patients with aHCC treated with SBRT were collected from the hospital electronic records. Patients with Child-Turcotte-Pugh status (CTP) A5 to B8 and a functional liver reserve of >= 700cc were included. Local control, overall survival (OS), progression-free survival (PFS), and postprocedure adverse events were recorded. Results:The median follow-up period of the study cohort was 13 months (range: 3-36 months). The median age was 75 years (range: 70-84 years) with CTP A (70.8%) and CTP B (29.2%). NASH was the most common etiology (n = 15, 62.5%). The median tumor diameter was 8.5 cm (range, 5-16). Portal vein and IVC tumor thrombosis were seen in 21 (87.5%) and 4 (16.67%) patients. The median SBRT dose to gross tumor of 35 Gy (range 25-40 Gy) is delivered in five fractions. Though the median AFP level was reduced from 136.5 (range 3.7-27533) to 34.5 (range 3-4964) ng/ml, the difference was not significant. The median PIVKA II level was significantly decreased from 2702 (range 23.8-385454) to 189 (range 15-56262) mAU/ml, P = 0.05. The estimated local control rates at 12 and 18 months were 90% and 62%, respectively. The 1-year estimated OS and PFS rates were 58% and 42%, respectively. The mOS and mPFS were 14 months (95% CI, 8.5-19.4) and 9 months (95% CI, 5.5-12.4), respectively. On multivariate analysis, baseline geriatric 8 (G8) score <= 9 and CTP B were the predictors of poor OS. SBRT was found to be generally safe in patients with geriatric 8 score >9 with postprocedure decompensation (increased CTP score by 2 points) in only one (4.16%) patient. Conclusion:SBRT is a safe and effective locoregional therapy in elderly subjects with cirrhosis and locally advanced HCC. In elderly patients, with limited transplant and other therapeutic options, SBRT is safe and provides improved local disease control, OS, and PFS.