J Korean Med Sci.  2012 Jul;27(7):736-743. 10.3346/jkms.2012.27.7.736.

Scheduled Interval Trans-Catheter Arterial Chemoembolization Followed by Radiation Therapy in Patients with Unresectable Hepatocellular Carcinoma

Affiliations
  • 1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. hee.ro.park@samsung.com
  • 2Department of Radiation Oncology, College of Medicine, Inje University Pusan Paik Hospital, Busan, Korea.
  • 3Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Combination treatment of trans-catheter arterial chemoembolization (TACE) and conformal radiation therapy (RT) reported promising results in patients with hepatocellular carcinoma (HCC), but, optimal interval was not determined. We hypothesized that a two-week interval between TACE and RT would be optimal. Therefore, we designed this study to evaluate the safety and efficacy of scheduled interval TACE followed by RT. HCC patients who were not eligible for standard therapies were enrolled for scheduled interval TACE followed by RT (START). Patients received TACE on the first day of treatment, and then RT was delivered after 14 days. The entire course of treatment took between four and five weeks. In 81 patients (96.4%), START was completed in the planned treatment period. RT was delayed in the remaining three patients because of decreased liver function or poor performance status after TACE. Of the 81 patients, objective response was observed in 57 patients (70.4%). One unexpected death occurred after START due to hepatic failure. Other toxicities were manageable. The median survival was 14.7 months. There was a significant difference in overall survival according to the response to START (P < 0.001). In conclusion, START is safe and feasible.

Keyword

Carcinoma, Hepatocellular; Radiationtherapy; Trans-Catheter Arterial Chemoembolization; Combination Treatment

MeSH Terms

Adult
Carcinoma, Hepatocellular/mortality/radiotherapy/*therapy
Combined Modality Therapy
*Embolization, Therapeutic
Female
Humans
Kaplan-Meier Estimate
Liver Neoplasms/mortality/radiotherapy/*therapy
Male
Middle Aged
Prognosis
Severity of Illness Index

Figure

  • Fig. 1 Study design. All eligible patients were treated by trans-catheter arterial chemoembolization and underwent standard clinical and laboratory studies on day 7 after TACE. If the patient was considered suitable for RT, RT simulation was performed that day and radiation therapy, was delivered at day 14 after TACE. OPD, outpatient department; RO, radiation oncology.

  • Fig. 2 Overall survival of all 81 patients with HCC treated by START: Kaplan-Meier curves for overall survival (A) and overall survival according to tumor response after START (B).


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Reference

1. Forner A, Reig ME, de Lope CR, Bruix J. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis. 2010. 30:61–74.
2. Higuchi T, Kikuchi M, Okazaki M. Hepatocellular carcinoma after transcatheter hepatic arterial embolization. A histopathologic study of 84 resected cases. Cancer. 1994. 73:2259–2267.
3. Oh D, Lim do H, Park HC, Paik SW, Koh KC, Lee JH, Choi MS, Yoo BC, Lim HK, Lee WJ, et al. Early three-dimensional conformal radiotherapy for patients with unresectable hepatocellular carcinoma after incomplete transcatheter arterial chemoembolization: a prospective evaluation of efficacy and toxicity. Am J Clin Oncol. 2010. 33:370–375.
4. Kim DY, Park W, Lim DH, Lee JH, Yoo BC, Paik SW, Kho KC, Kim TH, Ahn YC, Huh SJ. Three-dimensional conformal radiotherapy for portal vein thrombosis of hepatocellular carcinoma. Cancer. 2005. 103:2419–2426.
5. Seong J, Park HC, Han KH, Lee DY, Lee JT, Chon CY, Moon YM, Suh CO. Local radiotherapy for unresectable hepatocellular carcinoma patients who failed with transcatheter arterial chemoembolization. Int J Radiat Oncol Biol Phys. 2000. 47:1331–1335.
6. Korean Liver Cancer Study Group and National Cancer Center, Korea. Practice guidelines for management of hepatocellular carcinoma 2009. Korean J Hepatol. 2009. 15:391–423.
7. Hidajat N, Wust P, Felix R, Schröder R. Radiation dose of the radiologist and the assistant in transarterial hepatic chemoembolization: comparison with the dose limits. Rofo. 2006. 178:185–190.
8. Dawson LA, Guha C. Hepatocellular carcinoma: radiation therapy. Cancer J. 2008. 14:111–116.
9. Yoon SM, Lim YS, Won HJ, Kim JH, Kim KM, Lee HC, Chung YH, Lee YS, Lee SG, Park JH, et al. Radiotherapy plus transarterial chemoembolization for hepatocellular carcinoma invading the portal cein: long-term patient outcomes. Int J Radiat Oncol Biol Phys. 2011. 82:2004–2011.
10. Park HC, Seong J, Han KH, Chon CY, Moon YM, Suh CO. Dose-response relationship in local radiotherapy for hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2002. 54:150–155.
11. Seong J. Challenge and hope in radiotherapy of hepatocellular carcinoma. Yonsei Med J. 2009. 50:601–612.
12. Shim SJ, Seong J, Han KH, Chon CY, Suh CO, Lee JT. Local radiotherapy as a complement to incomplete transcatheter arterial chemoembolization in locally advanced hepatocellular carcinoma. Liver Int. 2005. 25:1189–1196.
13. Meng MB, Cui YL, Lu Y, She B, Chen Y, Guan YS, Zhang RM. Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and metaanalysis. Radiother Oncol. 2009. 92:184–194.
14. Ma S, Jiao B, Liu X, Yi H, Kong D, Gao L, Zhao G, Yang Y, Liu X. Approach to radiation therapy in hepatocellular carcinoma. Cancer Treat Rev. 2010. 36:157–163.
15. Park MK, Gwak GY, Lim do H, Choo SW, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC. The efficacy of combined transarterial chemoembolization and 3-dimensional conformal radiotherapy for hepatocellular carcinoma with main portal vein thrombosis. Hepatogastroenterology. 2010. 57:801–806.
16. Yu JI, Park HC, Lim do H, Park W, Yoo BC, Paik SW, Koh KC, Lee JH. Prognostic index for portal vein tumor thrombosis in patients with hepatocellular carcinoma treated with radiation therapy. J Korean Med Sci. 2011. 26:1014–1022.
17. Choi SB, Kim KS, Park YN, Choi JS, Lee WJ, Seong J, Han KH, Lee JT. The efficacy of hepatic resection after neoadjuvant transarterial chemoembolization (TACE) and radiation therapy in hepatocellular carcinoma greater than 5 cm in size. J Korean Med Sci. 2009. 24:242–247.
18. Xu LT, Zhou ZH, Lin JH, Chen Z, Wang K, Wang P, Zhu XY, Shen YH, Meng ZQ, Liu LM. Clinical study of transarterial chemoembolization combined with 3-dimensional conformal radiotherapy for hepatocellular carcinoma. Eur J Surg Oncol. 2011. 37:245–251.
19. Nakamura H, Hashimoto T, Oi H, Sawada S. Transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology. 1989. 170:783–786.
20. Li B, Yu J, Wang L, Li C, Zhou T, Zhai L, Xing L. Study of local three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for patients with stage III hepatocellular carcinoma. Am J Clin Oncol. 2003. 26:e92–e99.
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