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

• Yu JI
• Park HC
• Lim DH
• Kim CJ
• Oh D
• Yoo BC
• Paik SW
• Kho KC
• Lee JH

• KMID: 2157916
• DOI: http://doi.org/10.3346/jkms.2012.27.7.736

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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