Cancer Res Treat.  2019 Oct;51(4):1589-1599. 10.4143/crt.2018.687.

Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05)

Affiliations
  • 1Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea.
  • 2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea. irionywa@korea.ac.kr
  • 4Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. drsmyoon@amc.seoul.kr
  • 5Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 6Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 7Department of Radiation Oncology, Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
  • 8Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
  • 9Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea.
  • 10Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Korea.
  • 11Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 12Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
  • 13Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

Abstract

PURPOSE
There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B.
MATERIALS AND METHODS
We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologically effective dose (BED) ≥ 40 Gy₁₀ (α/β = 10 Gy). A total of 184 patients were included in this study.
RESULTS
Initial CP score was seven in 62.0% of patients, eight in 31.0%, and nine in 7.0%. Portal vein tumor thrombosis was present in 66.3% of patients. The BED ranged from 40.4 to 89.6 Gy₁₀ (median, 56.0 Gy₁₀). After RT completion, 48.4% of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9% and 39.8%, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7% experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD.
CONCLUSION
Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.

Keyword

Child-Pugh B; Hepatocellular carcinoma; Hepatic toxicity; Radiotherapy

MeSH Terms

Carcinoma, Hepatocellular*
Classification*
Disease-Free Survival
Humans
Korea*
Liver
Liver Diseases
Multivariate Analysis
Portal Vein
Radiotherapy
Radiotherapy, Conformal*
Retrospective Studies
Thrombosis
Treatment Outcome*

Figure

  • Fig. 1. Flowchart of evaluable patients’ recruitment process for toxicity analysis.

  • Fig. 2. Local progression-free survival (LPFS) (A), intrahepatic progression-free survival (IPFS) (B), and overall survival (OS) (C) curves.

  • Fig. 3. Hepatic toxicity defined as classic and non-classic radiation-induced liver disease (RILD) within 3 months after the end of radiotherapy in 184 patients (entire cohort, A) and in 132 patients (evaluable cohort, B). CP, Child-Pugh classification.


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