Cancer Res Treat.  2016 Apr;48(2):574-582. 10.4143/crt.2015.076.

Do Biliary Complications after Hypofractionated Radiation Therapy in Hepatocellular Carcinoma Matter?

• Yu JI
• Park HC
• Lim DH
• Paik SW

• KMID: 2454335
• DOI: http://doi.org/10.4143/crt.2015.076

Abstract

PURPOSE
The purpose of this study is to evaluate the efficacy of hypofractionated radiation therapy (RT) in the treatment of unresectable hepatocellular carcinoma (HCC) after failure of transarterial chemoembolization (TACE) or in cases of refractory HCC, and to investigate biliary complications after hypofractionated RT.
MATERIALS AND METHODS
We retrospectively enrolled patients with unresectable, TACE-unresponsive, or refractory HCC treated with hypofractionated RT between July 2006 and December 2012. The perihilar region was defined as the 1-cm area surrounding the right, left, and the common hepatic duct, including the gallbladder and the cystic duct. Significant elevation of total bilirubin was defined as an increase of more than 3.0 mg/dL, and more than two times that of the previous level after completion of RT.
RESULTS
Fifty patients received hypofractionated RT and 27 (54%) had a tumor located within the perihilar region. The median follow-up period was 24.7 months (range, 4.3 to 95.5 months). None of the patients developed classic radiation disease symptoms, but four patients (8%) showed significant elevation of total bilirubin within 1 year after RT. During follow-up, 12 patients (24%) developed radiologic biliary abnormalities, but only two patients had toxicities requiring intervention. Estimated local progression-free survival, progression-free survival, and overall survival of the patients at 3-year post-hypofractionated RT were 89.7%, 11.2%, and 57.4%, respectively.
CONCLUSION
Biliary complications associated with a higher dose exposure of hypofractionated RT were minimal, even in the perihilar region. Hypofractionated RT provided excellent local control and may be a valuable option for treatment of unresectable cases of TACE-unresponsive or refractory HCC.

Keyword

Hepatocellular carcinoma; Radiotherapy; Dose fractionation; Toxicity

MeSH Terms

Bilirubin
Carcinoma, Hepatocellular*
Cystic Duct
Disease-Free Survival
Dose Fractionation
Follow-Up Studies
Gallbladder
Hepatic Duct, Common
Humans
Radiotherapy
Retrospective Studies
Bilirubin

Figure

• 

  Fig. 1. Kaplan-Meier curves of local progression-free survival (LPFS), progression-free survival (PFS), and overall survival (OS) in all enrolled patients; OS and LPFS were 57.4% and 89.7% at 3 years, respectively, but PFS was only 11.2%.

• 

  Fig. 2. Biliary stricture after hypofractionated radiation therapy (RT) in unresectable hepatocellular carcinoma. The tumor in segment 8 invaded the bile duct at the hilum side (A, B). The tumor regressed over 4 months following RT (C, D), but the patient experienced concurrent continuous aggravated jaundice (E) and, above the irradiated area, bile duct dilatation was confirmed after percutaneous bile duct drainage (F). Target lesion (white arrow, before RT; yellow arrow, after RT).

Reference

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