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Factors affecting survival after concurrent chemoradiation therapy for advanced hepatocellular carcinoma: a retrospective study

 Ja Kyung Kim  ;  Jun Won Kim  ;  Ik Jae Lee  ;  Seung-Moon Joo  ;  Kwang-Hun Lee  ;  Eun-Suk Cho  ;  Jeong-Sik Yu  ;  Tae Joo Jeon  ;  Yonsoo Kim  ;  Jung Il Lee  ;  Kwan Sik Lee 
 RADIATION ONCOLOGY, Vol.12(1) : 133, 2017 
Journal Title
Issue Date
Adult ; Aged ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/therapy* ; Chemoembolization, Therapeutic ; Chemoradiotherapy/methods* ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms/mortality ; Liver Neoplasms/therapy* ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Treatment Outcome
Chemoembolization ; Chemoradiotherapy ; Hepatocellular carcinoma ; Radiotherapy
BACKGROUND: Concurrent chemoradiation therapy (CCRT) followed by hepatic arterial infusional chemotherapy (HAIC) was reported to be effective for advanced hepatocellular carcinoma (HCC) with portal vein thrombosis. However, transarterial chemoembolization (TACE) is not preferred in this setting. The aim of this study was to assess the factors affecting survival after CCRT, including additional TACE during repeated HAIC.

METHODS: Thirty-eight patients who underwent CCRT as the initial treatment for Barcelona Clinic Liver Cancer stage C HCC with vascular invasion between 2009 and 2016 were reviewed retrospectively. During CCRT, 5-fluorouracil (5-FU) was infused via chemoport during the first and last five days of five weeks of external beam radiation therapy. After CCRT, repeated HAIC with cisplatin and 5-FU was performed monthly. Nineteen patients (50%) underwent additional TACE between repeated HAICs. Factors related to overall survival and progression free survival (PFS) were analyzed.

RESULTS: The mean age of patients was 55 years (male:female, 33:5). Underlying liver diseases were hepatitis B, hepatitis C and non-B/C in 29, 1 and 8 patients, respectively. The median radiation dose was 4500 cGy. The objective response (OR) rate at one months after CCRT was 36.8%. The median PFS was 7.4 (range, 1.8 - 32.1) months. The median overall survival was 11.6 (range 2.8-65.7) months. Achieving an OR after CCRT (hazard ratio [HR], 0.028; P < 0.001), additional TACE (HR, 0.134, P < 0.001), and further rounds of HAIC (HR, 0.742, P = 0.001) were independent significant factors related to overall survival. The overall survival duration of patients with an OR after CCRT (median 44.2 vs. 6.6 months, P < 0.001) and additional TACE (median 19.8 vs. 9.1 months, P = 0.001) were significantly greater than those without an OR after CCRT or additional TACE.

CONCLUSION: Patients who achieved an OR after CCRT, underwent additional TACE, and were subjected to repeated rounds of HAIC following CCRT showed better survival after CCRT for advanced stage of HCC with vascular invasion. A further prospective study is needed to confirm the positive effect of additional TACE after CCRT.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ja Kyung(김자경) ORCID logo https://orcid.org/0000-0001-5025-6846
Kim, Jun Won(김준원) ORCID logo https://orcid.org/0000-0003-1358-364X
Yu, Jeong Sik(유정식) ORCID logo https://orcid.org/0000-0002-8171-5838
Lee, Kwan Sik(이관식) ORCID logo https://orcid.org/0000-0002-3672-1198
Lee, Kwang Hun(이광훈)
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
Lee, Jung Il(이정일) ORCID logo https://orcid.org/0000-0002-0142-1398
Jeon, Tae Joo(전태주) ORCID logo https://orcid.org/0000-0002-7574-6734
Cho, Eun Suk(조은석)
Joo, Seung Moon(주승문) ORCID logo https://orcid.org/0000-0002-0647-2880
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