Clinical Study Oncology 2014;87(suppl 1):82–89 DOI: 10.1159/000368150
Published online: November 22, 2014
Multimodality Treatment with Radiotherapy for Huge Hepatocellular Carcinoma Hee Ji Han a Mi Sun Kim a Jihye Cha a Jin Sub Choi b Kwang Hyub Han c Jinsil Seong a Departments of a Radiation Oncology, b Surgery and c Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
Abstract Background: For huge hepatocellular carcinoma (HCC), therapeutic decisions have varied from local therapy to systemic therapy, with radiotherapy (RT) playing only a palliative role. In this study, we investigated whether multimodality treatment involving RT could be effective in huge HCC. Results: This study was performed in 116 patients with HCC >10 cm. The number of patients in stage II, III and IV was 12, 54 and 50, respectively. RT was given as a combined modality in most patients. The median dose was 45 Gy, with 1.8 Gy per fraction. The median overall survival (OS) and progression-free survival (PFS) were 14.8 and 6.5 months, respectively. The median infield PFS was not reached. Infield failure, outfield intrahepatic and extrahepatic failure were observed in 8.6, 18.1, and 12.1% of patients, respectively. For OS and PFS, number of tumors, initial alpha-fetoprotein (AFP) level, treatment response, percent AFP decrement, and hepatic resection were significant prognostic factors. Tumor characteristics and treatment response were significantly different
© 2014 S. Karger AG, Basel 0030–2414/14/0877–0082$39.50/0 E-Mail [email protected] www.karger.com/ocl
between long-term survivors and the other patients. Conclusion: Although huge HCC presents an aggressive clinical course, multimodality approaches involving RT can offer an opportunity for prolonged survival. © 2014 S. Karger AG, Basel
Introduction
Patients with early stage hepatocellular carcinoma (HCC) are candidates for curative treatments such as hepatic resection and liver transplantation [1–5], but most patients are not initially diagnosed until HCC has progressed to an advanced-stage disease. Unfortunately, these patients have more limited options for effective treatments [6]. In large HCC tumors, more aggressive biological behaviors are exhibited than in smaller tumors. Large tumors are also often accompanied by vessel invasion, intrahepatic dissemination, and lymph node (LN) metastasis. These features are reported as independent factors that can predict poor survival after treatment of advanced HCC [7, 8]. Consequently, patients with large HCC tumors show worse survival and disease-control rates than patients with smaller tumors. Prof. Jinsil Seong Department of Radiation Oncology, Severance Hospital Yonsei University College of Medicine 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Korea) E-Mail jsseong @ yuhs.ac
Downloaded by: University of New South Wales 198.143.52.17 - 4/15/2016 8:37:01 PM
Key Words Hepatocellular carcinoma · Radiotherapy · Multimodality treatment
Materials and Methods We retrospectively reviewed the records of 116 patients with unresectable HCC treated with RT at our institution between July 2001 and December 2010. A diagnosis of HCC was based on histology or clinicoradiological criteria under the practice guidelines of the Korean Liver Cancer Study Group [23]. The criteria for entry into this study were as follows: (1) the tumor was >10 cm, (2) radiation of a minimum of 45 Gy was delivered, and (3) there was no evidence of distant metastasis. We excluded patients who had double primary malignancies or those with
Published online: November 22, 2014
Multimodality Treatment with Radiotherapy for Huge Hepatocellular Carcinoma Hee Ji Han a Mi Sun Kim a Jihye Cha a Jin Sub Choi b Kwang Hyub Han c Jinsil Seong a Departments of a Radiation Oncology, b Surgery and c Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
Abstract Background: For huge hepatocellular carcinoma (HCC), therapeutic decisions have varied from local therapy to systemic therapy, with radiotherapy (RT) playing only a palliative role. In this study, we investigated whether multimodality treatment involving RT could be effective in huge HCC. Results: This study was performed in 116 patients with HCC >10 cm. The number of patients in stage II, III and IV was 12, 54 and 50, respectively. RT was given as a combined modality in most patients. The median dose was 45 Gy, with 1.8 Gy per fraction. The median overall survival (OS) and progression-free survival (PFS) were 14.8 and 6.5 months, respectively. The median infield PFS was not reached. Infield failure, outfield intrahepatic and extrahepatic failure were observed in 8.6, 18.1, and 12.1% of patients, respectively. For OS and PFS, number of tumors, initial alpha-fetoprotein (AFP) level, treatment response, percent AFP decrement, and hepatic resection were significant prognostic factors. Tumor characteristics and treatment response were significantly different
© 2014 S. Karger AG, Basel 0030–2414/14/0877–0082$39.50/0 E-Mail [email protected] www.karger.com/ocl
between long-term survivors and the other patients. Conclusion: Although huge HCC presents an aggressive clinical course, multimodality approaches involving RT can offer an opportunity for prolonged survival. © 2014 S. Karger AG, Basel
Introduction
Patients with early stage hepatocellular carcinoma (HCC) are candidates for curative treatments such as hepatic resection and liver transplantation [1–5], but most patients are not initially diagnosed until HCC has progressed to an advanced-stage disease. Unfortunately, these patients have more limited options for effective treatments [6]. In large HCC tumors, more aggressive biological behaviors are exhibited than in smaller tumors. Large tumors are also often accompanied by vessel invasion, intrahepatic dissemination, and lymph node (LN) metastasis. These features are reported as independent factors that can predict poor survival after treatment of advanced HCC [7, 8]. Consequently, patients with large HCC tumors show worse survival and disease-control rates than patients with smaller tumors. Prof. Jinsil Seong Department of Radiation Oncology, Severance Hospital Yonsei University College of Medicine 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Korea) E-Mail jsseong @ yuhs.ac
Downloaded by: University of New South Wales 198.143.52.17 - 4/15/2016 8:37:01 PM
Key Words Hepatocellular carcinoma · Radiotherapy · Multimodality treatment
Materials and Methods We retrospectively reviewed the records of 116 patients with unresectable HCC treated with RT at our institution between July 2001 and December 2010. A diagnosis of HCC was based on histology or clinicoradiological criteria under the practice guidelines of the Korean Liver Cancer Study Group [23]. The criteria for entry into this study were as follows: (1) the tumor was >10 cm, (2) radiation of a minimum of 45 Gy was delivered, and (3) there was no evidence of distant metastasis. We excluded patients who had double primary malignancies or those with
