Outcomes of 5- Versus 10-Fraction Radiation Therapy for Hepatocellular Carcinoma at a Veteran Affairs Hospital.

PURPOSE: To compare outcomes, liver toxicity, and survival between patients with hepatocellular carcinoma treated with hypofractionaed image-guided radiation therapy (HIGRT) delivered in 5 versus 10 fractions within a Veterans Affairs (VA) population. METHODS AND MATERIALS: A retrospective review was performed of patients with unresectable or medically inoperable hepatocellular carcinoma treated with HIGRT at the Durham VA Medical Center between 2013 and 2024. Patients treated with palliative intent or lacking follow-up were excluded. The standard regimen was 50 Gy in 5 fractions; 50 Gy in 10 fractions was used when organ-at-risk constraints precluded 5-fraction delivery. Demographic, clinical, and dosimetric data were extracted from the VA National Corporate Data Warehouse. Outcomes were analyzed using Kaplan-Meier and Cox proportional hazards models. RESULTS: Among 147 patients (median age, 67 years), 96 received 50 Gy in 5 fractions and 51 received 50 Gy in 10 fractions. Most patients had cirrhosis (93.9%) and Child-Pugh class A liver function (82.3%). Tumors were larger in the 10-fraction cohort (median, 35 cm3 vs 14 cm3; P < .001). Treatment was well tolerated, with only 1 grade 3 event and no grade ≥4 toxicity. The cumulative grade ≥2 toxicity was similar between regimens (hazard ratio, 1.59; P = .25). Worsening of Child-Pugh score by ≥2 points occurred more frequently with 10 fractions (hazard ratio 2.15; P < .01), but this was associated only with higher mean liver dose in a multivariate model. Two-year local control was 90.7% for 5 fractions and 82.4% for 10 fractions; this difference was not significant after adjusting for tumor size. Median overall survival was 2.8 years, shorter in the 10-fraction cohort due to poorer baseline characteristics. CONCLUSIONS: Both 50 Gy in 5 and 10 fractions achieved excellent local control and minimal toxicity. The 10-fraction regimen is a safe, effective alternative when normal tissue constraints preclude 5-fraction HIGRT.

Duke Scholars

Author Matthew Jacob Boyer Radiation Oncology

Author Devon James Godfrey Radiation Oncology

Author Joseph Kamel Salama Radiation Oncology