Work

93: Outcome of Radiotherapy for Aggressive forms of Basal Cell Carcinoma of the Head and Neck

Year: 2016

Type: article

Abstract: Purpose: Primary hepatocellular (HCC) and secondary liver metastases (METS) is a growing problem.Despite the increasing use of liver stereotactic body radiotherapy (SBRT), there is a lack of a predictive model to understand which patients benefit from treatment.This study developed a model to improve patient selection for radical radiotherapy for liver malignancies.Methods and Materials: Two hundred and twelve (HCC (31%), METS (69%)) patients were identified.We excluded those receiving low dose palliative radiation.Patients dying within four months were deemed to have failed to benefit from radiation.Both patient and tumour parameters were selected for univariate analysis.Patient factors included age, sex and liver function (Child-Pugh (CP) score, serum albumin (ALB), total bilirubin, prothrombin time, presence of ascites).Tumour factors included gross tumour volume (GTV), number of lesions, presence of extrahepatic disease (ED), previous treatments (resection, chemotherapy, chemoembolization) and primary disease site if metastatic.Multivariable regression analysis was used to develop a clinical predictive tool.Results: For HCC, CP score and a larger GTV were found to be significant predictors of early death.For the METS group, ALB, presence of ED and colorectal primary were significant predictors.For the combined set, CP score (HR = 0.7), ALB (HR = 1.1), previous resection (HR = 5.2) and presence of ED (HR = 0.4) were significant predictors.Chi-squared analysis showed a significant (p < 0.01) reduction in deviance indicating that the model has good predictive value.ANOVA indicated that while each variable significantly reduced the residual deviance, the model is not saturated.Conclusions: A model was developed to identify patients who are unlikely to benefit from radiation.The model is not saturated and additional variables need to be identified.Multi-institutional collaboration is required to obtain a larger sample size, as single centres are unlikely to obtain sufficient numbers for this disease site.Until then, all patients meeting commonly accepted liver SBRT eligibility should be offered radiation.

Source: Radiotherapy and Oncology

DOI: 10.1016/s0167-8140(16)33492-2