Effect of daily and every other day stereotactic body radiotherapy (SBRT) schedules on treatment-related fatigue in patients with Hepatocellular Carcinoma (HCC)

Publication date: Available online 3 July 2018
Source:Practical Radiation Oncology
Author(s): Shaakir Hasan, Paul Renz, Matthew Packard, Sean Horrigan, Steven Gresswell, Alexander V. Kirichenko
PurposeWe compared the rate and severity of fatigue in patients who completed stereotactic body radiotherapy (SBRT) to the liver daily(QD) compared with every other day(QOD)Methods and MaterialsFrom 2010 to 2017, 91 patients with Child Pugh(CP) A(n=57) or CP-B (34) cirrhosis who completed 100 SBRT sessions to 110 HCC lesions were analyzed in this study. Confounding variables with fatigue such as CP-C cirrhosis, ECOG over 2, or a history of ascites/encephalopathy were excluded. Fatigue was assessed against several treatment/patient related variables with univariate and propensity score-matched multivariate analysis. Median follow-up was 18 months.ResultsHCC patients with BCLC stages 0(n=10), A(n=32), and B(n=58) and a median age of 62 were analyzed. Median tumor diameter was 3 cm (1.1-11 cm). ECOG performance status was 0(n=44), 1(n=43), or 2(n=13). The median dose was 45 Gy in 5 fractions. 65 treatments were QD and 45 were QOD.Grade 1 and 2 fatigue developed in 49% and 14% of treatments, respectively. Among those treated daily, 78% developed G1/G2 fatigue compared to 44% treated QOD (OR=4.52, P=0.001). Grade 2 fatigue occurred in 22% compared to 7.3% for QD and QOD treatment, respectively (OR=3.83, P=0.048). There was no difference in fatigue rate for time of treatment(morning/afternoon), dose, treated volume, CP score, BCLC stage, or performance status were not associated with any level of fatigue. There were no difference in local control between QD and QOD treatments.ConclusionsCompared to traditional daily treatment fractions, SBRT delivered QOD to cirrhotic patients with HCC may reduce the risk of fatigue.



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