Risk Factor Evaluation for Hepatic Decompensation after Stereotactic Body Radiation Therapy in Patients with Hepatocellular Carcinoma

Abstract

Purpose: We examined the risk factors for patients with hepatocellular carcinoma (HCC) with underlying liver cirrhosis after undergoing stereotactic body radiation therapy (SBRT) with the primary endpoint of hepatic decompensation event. Materials and Methods: This retrospective study reviewed the patients who underwent SBRT for HCC at Asan Medical Center from 2007 to 2017. Patients with a disease-free period of >2 years without history of decompensation event prior to SBRT were included. The patients were delivered a total dose of median 45 Gy in 3 fractions over consecutive days. Logistic regression was applied to patients’ clinical and dosimetric factors for multivariate analysis, and the final model was evaluated through receiver operating characteristic (ROC) curve. Results: The data of 138 patients were analyzed (median follow-up, 48.8 months; median age, 63 years; male sex, 76%; hepatitis B viral [HBV] etiology, 72%). Hepatic decompensation events occurred in 14 (10.1%) patients during the follow-up period. Patients were divided into the compensated and decompensated groups according to the occurrence of hepatic decompensation. In the compensated group, there were 25 women (20%) and 94 patients with HBV-associated cirrhosis (76%), whereas there were eight women (57%) and six patients with HBV (43%) in the decompensated group (p=0.005 and 0.022, respectively). There was a significant difference in the baseline platelet count and prothrombin time (p<0.05). The multivariate analysis revealed that sex, HBV status, platelet count, and V15 Gy (normal liver volume irradiated with ≥15 Gy) were associated with decompensation event risk. The model exhibited a balanced goodness of fit, moderate discrimination, and an area under the curve of 0.8629 in ROC curve analysis, indicating its potential for predicting hepatic decompensation event risk. Conclusion: In conclusion, sex, etiology of liver cirrhosis, baseline platelet count, and V15 Gy affected the occurrence of long-term hepatic decompensation event after SBRT in patients with HCC. These findings may help us establish the individualized dose constraints for each patient. Keywords: hepatocellular carcinoma, stereotactic body radiation therapy, hepatic decompensation.