SBRT for Hepatocellular Carcinoma Patients With Partial Response to TACE

Inclusion Criteria

• •HCC diagnosis according to the American Association for the Study of Liver Diseases (AASLD) 2010 criteria
• •Tumor Stage
• •liver only disease
• •tumor thrombus at segment is allowed
• •no extra hepatic metastases
• •tumor encompassing less than 50% of hepatic volume
• •previous treatment with Transarterial Chemo Embolization (TACE) - patient must have performed at least 2 sessions of TACE and have signs of viable tumor in CT or MRI performed 30-40 days after last TACE
• •presence of measurable lesion (at least one lesion that can be measured equal or more than 1 cm in CT or MRI).
• •Maximum lesion size of 10 cm.
• •Liver residual volume equal or more than 700cc or 40% of total liver volume
• •Child-Pugh A or absence of hepatic cirrhosis
• •absence of encephalopathy or ascitis on clinical exam
• •Eastern Cooperative Oncology Group (ECOG) performance status 0-1
• •Lab exams:
• •hemoglobin \> or equal 8 mg/dl
• •neutrophils \> or equal 1.200/mm³
• •platelets \> or equal 45.000/mm³
• •alanine aminotransferase (ALT) and aspartate aminotransferase (AST) less than 6 times the upper normal limit
• •bilirubin equal or \< 2 mg/dl
• •international normalized ratio (INR) \< 1.7
• •serum creatinine equal or \< 1.5 times the upper normal limit or creatinine clearance \> or equal 60 ml/min
• •Albumin \>2.8 mg/dl
• •not being pregnant - a negative pregnancy test is required (for women). Patients in fertile age should use a contraceptive method during treatment and 4 months after.