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Early α-fetoprotein response as a predictor for clinical outcome after localized concurrent chemoradiotherapy for advanced hepatocellular carcinoma

Title
 Early α-fetoprotein response as a predictor for clinical outcome after localized concurrent chemoradiotherapy for advanced hepatocellular carcinoma 
Authors
 Beom Kyung Kim ; Sang Hoon Ahn ; Kwang-Hyub Han ; Kwang Hoon Lee ; Do Youn Lee ; Ja Kyung Kim ; Do Young Kim ; Jun Yong Park ; Jin Sil Seong 
Issue Date
2011
Journal Title
 Liver International 
ISSN
 1478-3223 
Citation
 Liver International, Vol.31(3) : 369~376, 2011 
Abstract
BACKGROUNDS: There are limitations in using only radiological criteria to evaluate treatment outcomes in hepatocellular carcinoma (HCC). α-fetoprotein (AFP) is regarded as an indicator of tumour activity in HCC. AIMS: We present a novel correlation between AFP response and survival outcome in patients treated with localized concurrent chemoradiotherapy (CCRT). MATERIALS: From 2005 to 2008, 187 locally advanced HCC patients underwent localized CCRT (external beam radiotherapy at 45 Gy over 5 weeks plus a concurrent hepatic arterial infusion of 5-fluorouracil during the first/fifth week), followed by repetitive hepatic arterial infusional chemotherapy (HAIC) with 5-fluorouracil and cisplatin. Among them, 149 with an elevated baseline AFP level (>20 ng/ml) were finally studied. AFP response was defined as >50% decrease from baseline, 1 month after the completion of localized CCRT. RESULTS: Patients' characteristics were as follows: median age (52 years); Child-Pugh class A/B (n=137/12 respectively); and portal vein thrombosis (n=118). AFP responders (101 patients) had better objective responses than AFP non-responders (48 patients) after CCRT (44.5 vs. 12.5%; P<0.001) and subsequent HAIC (51.5 vs. 16.7%; P<0.001). Both median progression-free survival (PFS, 8.1 vs. 3.9 months; P<0.001) and overall survival (OS, 13.3 vs. 5.9 months; P<0.001) were longer in AFP responders than AFP non-responders. In multivariate analysis, AFP response and objective response were independent factors affecting PFS and OS. Furthermore, AFP non-responders were more likely to have extrahepatic metastasis within 6 months of treatments initiation than AFP responders (59.5 vs. 25.9%; P<0.001). CONCLUSIONS: Early AFP response may be useful not only in predicting prognosis and treatment response but also in establishing optimized treatment plans for HCC.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/94415
DOI
10.1111/j.1478-3231.2010.02368.x
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
1. 연구논문 > 1. College of Medicine > Dept. of Radiology
1. 연구논문 > 1. College of Medicine > Dept. of Radiation Oncology
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Link
 http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2010.02368.x/abstract
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