Central Hepatobiliary Adverse Events in Patients with Liver Malignancies Undergoing Stereotactic Body Radiotherapy

March 2022, Vol 3, No 1

Stereotactic body radiotherapy (SBRT) is increasingly being used for the treatment of patients with primary or metastatic liver cancer. A single-institution study was conducted to assess the incidence of central hepatobiliary adverse events (AEs) in patients with liver malignancies who were treated with SBRT, and to evaluate the relation with planned dosimetry to define predictors to minimize AEs. The results were presented by Nitika Thawani, Dignity Health Cancer Institute, Phoenix, AZ, at the 2022 ASCO GI Cancers Symposium.

A total of 43 patients with liver cancer who were treated with SBRT between March 2017 and July 2021 were included in the study. Overall, 40 patients were eligible for analysis. Of these, 31 patients had hepatocellular carcinoma, 6 had cholangiocarcinoma, and 3 had metastatic lesions.

Patients received 35 Gy to 50 Gy in 3 to 5 fractions; all patients were prospectively planned with common bile duct spared to a maximum dose of <50 Gy.

All patients had liver function tests at each fraction, and then every 3 months after. The investigators retrospectively contoured central hepatobiliary tree, defined as portal vein from confluence to division, with 1.5-cm margin expansion.

At a median follow-up of 8 months (range, 3-38 months), 35 patients with >3 months of follow-up were evaluated for subacute and chronic AEs. The local control rate at the primary disease site was 85%. The majority (80%) of patients had grade <2 AEs, 7.5% had grade 4 AEs, and 12.5% had grade 3 AEs. Portal-vein thrombosis was reported in 6 (15%) patients. All patients with grade 4 AEs had portal-vein thrombosis or lesion involving the hilum.

The median planning target volume was 241 cc (range, 21.5-1087.5 cc). The median dose was 40 Gy in 5 fractions. Although there was a trend of statistical significance for central hepatobiliary tree V30 and V40 (coeff 0.63), no statistically significant dosimetric association was found.

Based on these data, the investigators concluded that central hepatobiliary AEs occur in 7.5% of patients with liver cancer who are treated with SBRT, and portal-vein thrombosis is associated with an increased risk for such AEs. Moderate doses (30-40 Gy) are a predictor of AEs in patients with liver malignancies and should be limited when planning SBRT, especially in patients with portal-vein thrombosis.


Thawani N, Tan N, Pinnaduwage D, et al. Central hepatobiliary toxicity in patients treated with stereotactic body radiotherapy (SBRT) for liver malignancies. Abstract 409.

Related Items

Characterization of Long-Term Survivors in TOPAZ-1
March 2023, Vol 4, No 1
Researchers examined the characteristics, outcomes, and genomic profiles of patients with advanced biliary tract cancer who were treated with durvalumab plus gemcitabine/cisplatin and experienced long-term survival.
MDM2-p53 Antagonist BI 907828 Demonstrated Promising Activity in Patients with Advanced BTC
March 2023, Vol 4, No 1
The novel MDM2-p53 antagonist BI 907828 is being investigated as a first-line treatment in patients with advanced biliary tract cancer.
Treatment and Survival Outcomes with Systemic Therapy for Patients with BTC with IDH1 Mutations: A Retrospective Study
March 2023, Vol 4, No 1
Long-term outcomes were evaluated in patients with IDH1-mutated biliary tract cancer who were treated with systemic therapy.
Phase 2 Study of CTX-009 plus Paclitaxel in Patients with Advanced BTC
March 2023, Vol 4, No 1
CTX-009 plus paclitaxel showed promising efficacy as second- or third-line treatment in patients with advanced biliary tract cancer.
Gunagratinib in Patients with Previously Treated Advanced CCA Harboring FGFR2 Fusions or Rearrangements
March 2023, Vol 4, No 1
Gunagratinib showed promising efficacy as a second-generation FGFR inhibitor and demonstrated potential to treat multiple FGFR pathway abnormalities.
Results from SWOG 1815: GemCis and Nab-Paclitaxel versus GemCis in Advanced BTC
March 2023, Vol 4, No 1
The SWOG 1815 trial found that treatment with gemcitabine/cisplatin and paclitaxel (GAP) did not result in a significant improvement in survival compared with gemcitabine and cisplatin in patients with advanced biliary tract cancer, though GAP may be beneficial in patients with locally advanced disease and GBC.
JCOG1202 Subgroup Analysis: Risk Factors for Early Relapse in Patients Undergoing Curative Resection
March 2023, Vol 4, No 1
A study of patients with resected biliary tract cancer (BTC) found that postoperative CA 19-9 level, tumor differentiation, lymph node metastases, and residual tumor significantly impact early relapse in patients with curatively resected BTC. Similar risk factors were also found in patients receiving adjuvant S-1.
Impact of Gene Expression in 5-FU Metabolic Pathways on Outcomes in Patients Enrolled in JCOG1202
March 2023, Vol 4, No 1
Results from a study evaluating the impact of 5-FU metabolic pathway enzyme expression on outcomes of patients with curatively resected biliary tract cancer showed that relapse-free survival was improved in patients with certain enzymes who received adjuvant S-1.
Atezolizumab with or without Bevacizumab in Combination with GemCis in Advanced BTC: Results from IMbrave 151
March 2023, Vol 4, No 1
Researchers assessed whether VEGF blockade plus chemotherapy with gemcitabine/cisplatin can enhance responses to PD-L1 inhibition by promoting an immune-permissive tumor microenvironment in patients with advanced biliary tract cancer.
Nab-Paclitaxel plus Sintilimab as Second-Line Treatment for Advanced BTC
March 2023, Vol 4, No 1
The safety and efficacy of second-line nab-paclitaxel combined with the anti-PD-1 antibody sintilimab was studied in patients with advanced biliary tract cancer.

Subscribe Today!

To sign up for our newsletter or print publications, please enter your contact information below.

I'd like to receive: