Comparing Stereotactic Body Radiotherapy with Three-Dimensional Conformal Radiotherapy for Patients with Unresectable or Recurrent Hepatocellular Carcinoma

Purpose: To compare stereotactic body radiotherapy (SBRT) with three-dimensional conformal radiotherapy (3D-CRT) for improving hepatocellullar carcimona (HCC) patient survival rates.Material and Method: Forty-one patients with unresectable or recurrent HCC were divided into one group of 20 patients who received SBRT, and another group of 21 patients who received 3D-CRT. They were treated in the Radiation Oncology Department of the Tri-Service General Hospital from March 2007 to March 2009. The median follow-up time for all patients was 12 months (range 2 to 36 months). Overall survival was the primary end point.Results: For the 3D-CRT and SBRT patient groups, the median survival (MS) was 11 months and 16 months with the 1-year overall survival (OS) of 42.9% and 70.0%, respectively. In the univariate analysis, CyberKnife SBRT (p= 0.019), non-advanced Okuda stage (p= 0.002), serum albumin higher than 3.5g /dl (p= 0.008), and total bilirubin lower than 2.0 mg/dL (p= 0.042) were associated with significantly better OS. Further statistical analyses showed that those patients in Child-Pugh class A who received SBRT had better OS than those who received 3D-CRT (p= 0.047). Multivariate analyses revealed that Okuda stage (p= 0.006). Child-Pugh class (p= 0.042) and technique of RT (p= 0.029) were significant prognostic factors for OS.Conclusions: This study showed that patients who received SBRT had significantly better OS than those who received 3D-CRT. SBRT has the advantage of short overall treatment times compared to 3D-CRT. Our results also suggest that SBRT could be considered first in patients with Child-Pugh class A. Further study is required to define the effects of administered radiation dose and fractionation.