Cancer Res Treat.  2017 Jan;49(1):61-69. 10.4143/crt.2016.097.

Clinical Practice Patterns of Radiotherapy in Patients with Hepatocellular Carcinoma: A Korean Radiation Oncology Group Study (KROG 14-07)

• Cha H
• Park HC
• Yu JI
• Kim TH
• Nam TK
• Yoon SM
• Yoon WS
• Kim JW
• Kim MS
• Jang HS
• Choi Y
• Kim JH
• Kay CS
• Jung I
• Seong J

• KMID: 2367504
• DOI: http://doi.org/10.4143/crt.2016.097

Abstract

PURPOSE
The aim of this study was to examine patterns of radiotherapy (RT) in Korean patients with hepatocellular carcinoma (HCC) according to the evolving guideline for HCC established by the Korean Liver Cancer Study Group-National Cancer Center (KLCSG-NCC).
MATERIALS AND METHODS
We reviewed 765 patients with HCC who were treated with RT between January 2011 and December 2012 in 12 institutions.
RESULTS
The median follow-up period was 13.3 months (range, 0.2 to 51.7 months). Compared with previous data between 2004 and 2005, the use of RT as a first treatment has increased (9.0% vs. 40.8%). Increased application of intensity-modulated RT resulted in an increase in radiation dose (fractional dose, 1.8 Gy vs. 2.5 Gy; biologically effective dose, 53.1 Gy10 vs. 56.3 Gy10). Median overall survival was 16.2 months, which is longer than that reported in previous data (12 months). In subgroup analysis, treatments were significantly different according to stage (p < 0.001). Stereotactic body RT was used in patients with early HCC, and most patients with advanced stage were treated with three-dimensional conformal RT.
CONCLUSION
Based on the evolving KLCSG-NCC practice guideline for HCC, clinical practice patterns of RT have changed. Although RT is still used mainly in advanced HCC, the number of patients with good performance status who were treated with RT as a first treatment has increased. This change in practice patterns could result in improvement in overall survival.

Keyword

Hepatocellular carcinoma; Radiotherapy; Clinical practice pattern

MeSH Terms

Carcinoma, Hepatocellular*
Follow-Up Studies
Humans
Liver Neoplasms
Practice Patterns, Physicians'*
Radiation Oncology*
Radiotherapy*

Figure

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  Fig. 1. Overall survival. During the follow-up period, 455 patients died. Median overall survival for all patients was 16.2 months and the 2-year survival rate was 37.7%.

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  Fig. 2. (A) Pattern of failure. Assessment of treatment outcome was available in 734 patients (95.9%). Infield and outfield failure occurred in 235 (32.0%) and 547 (74.5%) patients. (B) Failure-free survival (FFS) for infield failure. Median FFS was not reached and 2-year FFS rate was 58.6%. (C) FFS for outfield failure. Median FFS was 9.8 months and 2-year FFS was 19.9%.

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  Fig. 3. Overall survival according to stage. Overall survival rates at 2 years in each stage were 76.7%, 60.4%, 42.9%, and 22.0%, respectively, and it was significantly different by stage (p < 0.001).

Reference

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