Stereotactic Body Radiation Therapy in Treating Patients With Liver Cancer That Cannot Be Removed by Surgery

Inclusion Criteria

• Life expectancy > 3 months
• Eastern Cooperative Oncology Group (ECOG) performance status = 200 ng/mL in the setting of cirrhosis or chronic hepatitis B/C
• HCC must be deemed unresectable by an experienced surgeon or patient must be medically inoperable or extra-hepatic metastases must be present (making resection an inappropriate treatment option) or patient must have declined the option of surgery after consultation with a surgeon
• Barcelona Clinic Liver Cancer score of B or C required (i.e., intermediate or advanced stage HCC)
• Prior liver resection or ablative therapy is permitted
• Prior transarterial chemoembolization (TACE) is permitted
• Patients must have recovered from the effects of previous therapy
• Maximal tumor size of 15 cm and > 700 cc of uninvolved liver
• Hemoglobin > 9.0 g/L
• Absolute neutrophil count >= 1.0 bil/L
• Platelets >= 70,000 bil/L
• Total bilirubin < 2 mg/dL
• International normalized ratio (INR) =< 1.5 or correctable with vitamin K (higher INR acceptable if patient is on Coumadin)
• Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 6 times upper range of normal

Exclusion Criteria

• Active hepatitis or encephalopathy related to liver failure
• Prior radiation therapy to the upper abdomen or thorax
• Lesions within 1 cm from the stomach
• Prior uncontrolled, life threatening malignancy within the previous 6 months
• Pregnancy is not permitted; women of child-bearing age must undergo pregnancy testing prior to enrollment
• Previous gastric, duodenal or variceal bleed within the past 2 months
• Thrombolytic therapy within 4 weeks or commencement of anticoagulant use within the past 3 months