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Local Radiotherapy for Unresectable Hepatocellular Carcinoma Patients who failed with transcatheter arterial chemoembolization

 Jinsil Seong  ;  Hee Chul Park  ;  Kwang Hyub Han  ;  Do Yun Lee  ;  Jong Tae Lee  ;  Chae Yoon Chon  ;  Young Myoung Moon  ;  Chang Ok Suh 
 International Journal of Radiation Oncology Biology Physics, Vol.47(5) : 1331-1335, 2000 
Journal Title
 International Journal of Radiation Oncology Biology Physics 
Issue Date
Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/radiotherapy* ; Carcinoma, Hepatocellular/therapy ; Chemoembolization, Therapeutic ; Female ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/radiotherapy* ; Liver Neoplasms/therapy ; Male ; Middle Aged ; Salvage Therapy ; Survival Rate ; Treatment Failure
Hepatocellular carcinoma ; Transcatheter arterial chemoembolization ; Radiotherapy
PURPOSE: The purpose of this study was to investigate the efficacy of local radiotherapy (RT) as a salvage treatment for unresectable hepatocellular carcinoma (HCC) patients who failed with transcatheter arterial chemoembolization (TACE). METHODS AND MATERIALS: Patients with unresectable HCC who had been treated with and eventually failed with TACE were eligible. The judgment of TACE failure was based on incomplete tumor filling of lipiodol-adriamycin mixture on either angiography or computed tomography (CT) scan. From January 1993 to December 1997, 27 patients were entered into this study. They had UICC Stage III (17) or IVA (10) disease, with a mean tumor size of 7.2 +/- 2.9 cm. Local RT was done, with a mean tumor dose of 51.8 +/- 7.9 Gy, in daily 1.8-Gy fractions using a 10- or 6-MV linear accelerator. Survival was calculated from both the diagnosis and the start of RT using the Kaplan-Meier method. RESULTS: An objective response was observed in 16 of 24 patients (66.7%) including 1 CR. Intrahepatic metastasis was noted outside the RT field in 10 patients (37.0%). Extrahepatic distant metastasis occurred in 4 patients. Survival rates at 1, 2, and 3 years were 85. 2%, 58.1%, and 33.2%, respectively, from the diagnosis and 55.9%, 35. 7%, and 21.4%, respectively, from the start of RT. The median survivals were 26 months from the diagnosis and 14 months from the start of RT. Acute toxicity involved alteration in liver function test (13 patients) and thrombocytopenia (2 patients). Subacute and chronic toxicity involved gastroduodenal ulcer (3 patients) and duodenitis (2 patients). There was no treatment-related death. CONCLUSION: In unresectable HCC patients who failed with TACE, local RT induced a substantial tumor response of 66.7%, with a 3-year survival rate of 21.4% and a median survival time of 14 months. Toxicity was significant but manageable. Although we do not know if there is survival benefit through this treatment, local RT in these patients seems to be valuable as a salvage for TACE-failed HCC.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
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