Stereotactic body radiation therapy for hepatocellular carcinoma: Experience from a tertiary cancer care center in India.

AIM: The aim of this retrospective study is to assess the toxicity and tumor response of stereotactic body radiation therapy (SBRT) protocol for hepatocellular carcinoma (HCC) in our institution. BACKGROUND: Hepatocellular cancer is one of the leading cancers among men in India. In recent years, SBRT has emerged as a promising tool in the treatment of HCC. MATERIALS AND METHODS: Ten patients diagnosed as HCC with Barcelona Clinic Liver Cancer Stage B and C, treated with SBRT technique from January 2013 to December 2016, were included in this study. SBRT was delivered using 6 MV photons with volumetric modulated arc therapy. Acute and late toxicities were graded, and tumor response was assessed using response evaluation criteria in solid tumors criteria. Kaplan-Meier curves were generated for progression-free survival (PFS) and overall survival (OS). RESULTS: The median age was 61.5 (52-69) years. The radiation dose ranged from 35 Gy to 60 Gy. All patients obtained partial response during assessment at 3 months after completion of treatment. The median PFS is 8 months (95% confidence interval [CI] - 5.22-10.77 months). The median OS is 51 months (95% CI - 17.64-65.10 months). The OS at 1 and 2 years is 75% and 57%, respectively. CONCLUSIONS: SBRT is well tolerated by our patients. The 1- and 2-year OS of 75% and 57% is consistent with other prospective and retrospective SBRT studies from the literature.

Management of Axilla in 2015 in Indian Scenario.

Sentinel lymph node biopsy is now increasingly being considered the favored method to treat low volume axilla. Most often this is followed by adjuvant radiation directed at axilla. In India however, sentinel node itself is still not widely practiced. The radiotherapy facilities are also not uniform, with cobalt units still being used in many centers. The long-term complications related to radiation are not assessed well. In fact there are also questions whether the evidence from early screen detected cancers in western population can be blindly followed in our population with a possibly different tumor biology and presentation as locally advanced being the norm. However, it is possible that we will see lesser axillary surgery in the minimal axillary disease group, in the not so distant future. We will look at the emerging evidence with an open mind and try to look at how this is applicable to our scenario.