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The Barcelona Clinic Liver Cancer stage C(BCLC-C) is defined by the presence of PVTT and/or  extrahepatic spread. Such patients are often treated with systemic therapy as there is no consensus on use of loco regional therapy in advanced/ metastatic HCC. Palliative SBRT is delivered with an aim to improve overall survival (OS), quality of life and local control of disease.

However, the extent of tumor burden and impairment in liver function may affect patient prognosis as well as treatment outcome. ALBI-T is one of the scoring system which predicts survival in advanced HCC and incorporates both tumor burden and LFT (S. Albumin and S. Bilirubin)

The Aim of the study is to sub-classify patients of BCLC-C on basis of tumor burden and LFT by using ALBI-T scoring system and further evaluating the efficacy of SBRT. 

It is an observational retrospective study done between May 2020 and Sep 2021. The data was collected from 33 patients with BCLC-C HCC, who were unsuitable for other liver-directed therapies. Patients with Child pugh score A5-B7 along with normal liver reserve ≥ 700cc were included. All patients were classified before SBRT by the ALBI-T scoring system. Cumulative survival rates were calculated using the Kaplan-Meier method and were compared using the log-rank test. 

In the cohort of 33 patients (table 1), Portal vein and IVC tumor thrombosis were present in 97% and 21% patients respectively. Lung and nodal metastasis were found in 33% and 79% patients respectively.

Median tumour volume was 600cc (100 - 1925). The median SBRT dose prescription was 35Gy (25-45Gy) in 5 to 10 fractions.

The 1 year LC and PFS were 90% and 40% respectively. The most common site of progression in patients were as follows: lungs (11) followed by nodes (6), liver (4) and bone (2).

The median survival of patients in entire cohort was 10 months (range 3 -20). The survival rate was 85% and 47% at 6 months and 1 year respectively.

There was a significant survival difference on sub classifying patients as per ALBI T score. The median OS of patients with ALBI-T score 2, 3, 4 and 5  is 14, 10, 8 and 4 months respectively (p=0.001).  At 1 year OS for score 2 was 100 %  whereas for score 3 and 4 was 42% each (p=0.001).

Sub-classification of BCLC stage C as per ALBI-T scoring system is required to minimize heterogeneity within the same tumor stage, that will help to predict survival and to select optimal treatment strategies.