Stereotactic radiotherapy with Gamma Master System® for palliation of hepatocellular carcinoma in patients with liver cirrhosis.

Background: Stereotactic radiotherapy with Gamma Master System^® delivered for portal vein tumor thrombosis (PVTT) located in the main portal vein is previously exploited. The study aimed to evaluate the efficacy and safety of stereotactic radiotherapy with Gamma Master System^® for palliation of hepatocellular carcinoma in patients with liver cirrhosis.

Methods: From March 2014 to March 2024, 96 patients (mean age, 59.7 ± 9.0, range, 39-87 years; 86, 89.6% males) with hepatocellular carcinoma and liver cirrhosis underwent stereotactic radiotherapy with Gamma Master System^® in our institute were retrospectively reviewed.

Results: Of the 96 patients, 80 (83.3%) patients demonstrated disease control, defined as 8 (8.3%) complete response, 63 (65.6%) partial response, and 9 (9.4%) stable disease. Median progression-free survival (PFS) was 6.0 ± 0.6 months [interquartile range (IQR), 3-14 months], with a 1-year PFS rate of 26.9%, the median overall survival (OS) reached 14.0 ± 1.3 months (IQR, 8-27 months), with an estimated 1-year survival rate of 61.8%. Of the 61 painful patients, 59 (96.7%) reported pain relief. The AFP decreased from 1070.5 ± 364.4 ng/ml before radiotherapy to 688.6 ± 301.5 ng/ml after radiotherapy (p = 0.081). Child-Pugh classification (A 74 cases, 77.1%, and B 22 cases, 22.6%) before radiotherapy was similar to that (A 74 cases, 77.1%, and B 22 cases, 22.6%) after radiotherapy, with 1 case changed from A to B and 1 case changed from B to A. Only one patient experienced grade 4 hematologic toxicity, which was managed with transfusion. Immune-related dermatitis occurred in 2 (7.1%) of the 28 patients combined with immunotherapy/targeted therapy. No other major complications were observed.

Conclusions: Stereotactic radiotherapy with Gamma Master System^® for palliation appears effective and safe in liver cirrhosis patients with hepatocellular carcinoma yielding a high rate of tumor response. This treatment may provide a valuable option for pain relief. Further study is warranted.