Clinical effect of stereotactic body radiotherapy in treatment of patients with small hepatocellular carcinoma and related prognostic factors

Objective To investigate the clinical effect and safety of stereotactic body radiotherapy ( SBRT) in patients with small hepatocellular carcinoma and related prognostic factors. Methods A retrospective analysis was performed for the clinical data of 64 patients with small hepatocellular carcinoma who underwent SBRT in 302 Hospital of PLA from March 2011 to October 2014. The patients were followed up for tumor control and adverse events after treatment. The Kaplan-Meier method was used to calculate survival rates, log-rank test and the Cox proportional hazards model was used to analyze the influencing factors for survival. Results A total of 64 patients with 72 lesions were enrolled in this study. The patients were followed up for 4-60 months, with a median follow-up time of 44 months. Of all lesions, 44 ( 61. 1%) achieved complete response, 20 ( 27. 8%) achieved partial response, 5 ( 6. 9%) achieved a stable state, and 3 ( 4. 2%) had progression. The objective response rate was 88. 9%. The 1-, 3-, and 5-year local control rates were 94. 4%, 88. 1%, and 78. 7%, respectively, the 1-, 3-, and 5-year cumulative survival rates were 95. 3%, 71. 6% and 55. 9%, respectively, and the 1-, 3-, and5-year progression-free survival rates were 62. 3%, 33. 5%, and 10. 8%, respectively. Most of the adverse events were grade 1-2 events. One patient experienced a grade 4 elevated bilirubin. In addition, about one fourth of the patients experienced grade 3 leukopenia and/or thrombocytopenia, which increased to the baseline level at 1 year after treatment. The multivariate analysis showed that albumin-bilirubin ( ALBI) grade and number of tumors were independent risk factors for the cumulative survival rate of patients with small hepatocellular carcinoma after SBRT. Conclusion SBRT is safe and effective in the treatment of small hepatocellular carcinoma, and ALBI grade and number of tumors are associated with the survival rate of patients after treatment.