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Clinical factors related to recurrence after hepatic arterial concurrent chemoradiotherapy for advanced but liver-confined hepatocellular carcinoma

Authors
 Hyejung Cha  ;  Hong In Yoon  ;  Ik Jae Lee  ;  Woong Sub Koom  ;  Kwang-Hyub Han  ;  Jinsil Seong 
Citation
 JOURNAL OF RADIATION RESEARCH, Vol.54(6) : 1069-1077, 2013 
Journal Title
JOURNAL OF RADIATION RESEARCH
ISSN
 0449-3060 
Issue Date
2013
MeSH
Adult ; Aged ; Carcinoma, Hepatocellular/mortality* ; Carcinoma, Hepatocellular/therapy* ; Chemoradiotherapy/statistics & numerical data* ; Disease-Free Survival ; Female ; Humans ; Liver Neoplasms/mortality* ; Liver Neoplasms/therapy* ; Male ; Middle Aged ; Neoplasm Recurrence, Local/mortality* ; Neoplasm Recurrence, Local/prevention & control* ; Recurrence ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Survival Rate ; Treatment Outcome
Keywords
hepatic arterial concurrent chemoradiotherapy (CCRT) ; hepatocellular carcinoma ; patterns of failure ; risk factors
Abstract
Before the sorafenib era, advanced but liver-confined hepatocellular carcinoma (HCC) was treated by liver-directed therapy. Hepatic arterial concurrent chemoradiotherapy (CCRT) has been performed in our group, giving substantial local control but frequent failure. The aim of this study was to analyze patterns of failure and find out predictive clinical factors in HCC treated with a liver-directed therapy, CCRT. A retrospective analysis was done for 138 HCC patients treated with CCRT between May 2001 and November 2009. Protocol-based CCRT was performed with local radiotherapy (RT) and concurrent 5-fluorouracil (5-FU) hepatic arterial infusion chemotherapy (HAIC), followed by monthly HAIC (5-FU and cisplatin). Patterns of failure were categorized into three groups: infield, intrahepatic-outfield and extrahepatic failure. Treatment failure occurred in 34.0% of patients at 3 months after RT. Infield, intrahepatic-outfield and extrahepatic failure were observed in 12 (8.6%), 26 (18.7%) and 27 (19.6%) patients, respectively. Median progression-free survival for infield, outfield and extrahepatic failure was 22.4, 18 and 21.5 months, respectively. For infield failure, a history of pre-CCRT treatment was a significant factor (P = 0.020). Pre-CCRT levels of alpha-fetoprotein and prothrombin induced by vitamin K absence or antagonist-II were significant factors for extrahepatic failure (P = 0.029). Treatment failures after CCRT were frequent in HCC patients, and were more commonly intrahepatic-outfield and extrahepatic failures than infield failure. A history of pre-CCRT treatment and levels of pre-CCRT tumor markers were identified as risk factors that could predict treatment failure. More intensified treatment is required for patients presenting risk factors.
Files in This Item:
T201305434.pdf Download
DOI
10.1093/jrr/rrt034
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pharmacology (약리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Yoon, Hong In(윤홍인) ORCID logo https://orcid.org/0000-0002-2106-6856
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/88995
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