In the past, treatment of patients with hepatocellular carcinoma (HCC) with large tumors or compromised liver function by stereotactic body radiation therapy (SBRT) has been hindered by intolerable toxicity levels and hepatic decline. Individualized therapy, improving the rate of local control while reducing the risk of toxicity, could enhance patient outcomes. In a prospective clinical trial, Herr and colleagues developed a quantitative, utility-based analysis that balances the probability of local tumor control with a patient's probability for treatment-related toxicity to optimize SBRT for HCC with large tumors or impaired liver function. When comparing patients receiving optimized SBRT treatment to patients receiving conventional SBRT by overlap weighting, the optimized SBRT group was found to have equivalent local control and decreased toxicity compared with conventional SBRT. The authors report a 2-year cumulative incidence of local progression of 6.4%, as well as similar one- and two-year freedom from progression rates and overall survival...

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