Document Type : Original Article(s)
Author
Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Abstract
Background: The incidence of hepatocellular carcinoma has significantly increased over the last decades and the prognosis of hepatocellular carcinoma still remains poor. The present study aimed to evaluate the efficacy and safety of 3D conformal hypofractionated radiotherapy in patients with small hepatocellular carcinoma.
Method: Between 2015 and 2018, a total of 61 patients presented to our institution with hepatocellular carcinoma ≤ 5cm, who were recruited in this prospective study. All the patients underwent 3D conformal hypofractionated radiotherapy with a total dose of 51 Gy in 17 fractions. We evaluated the treatment response and toxicity and calculated the local progression-free survival and overall survival.
Results: The objective response rate was 68.9%, including seven patients (11.5%) achieving complete response and 35 patients (57.4%) with partial response. In addition, nine subjects (14.8%) had stable disease. The 1-, 2-, and 3-year overall survival rates were 65.1%, 38.7%, and 26.4%, respectively. In multivariate Cox regression model, GTV was found to be the only prognostic factor for local control (P = 0.001) and overall survival (P < 0.001). Only one patient showed grade 3 radiation-induced hepatic toxicity (1.6%).
Conclusion: 3D conformal hypofractionated radiotherapy could be effective and safe in small hepatocellular carcinoma.
Keywords
How to cite this article:
Soliman M. The role of radical dose of radiotherapy in hepatocellular carcinoma. Middle East J Cancer. 2022;13(3):483-90. doi: 10.30476/mejc.2022.87504.1417.
- Global Burden of Disease Liver Cancer Collaboration, Akinyemiju T, Abera S, Ahmed M, Alam N, Alemayohu MA, et al. The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: Results from the global burden of disease study 2015. JAMA Oncol. 2017;3(12):1683-91. doi: 10.1001/jamaoncol.2017.3055.
- Forner A, Reig M, Bruix J. Hepatocellular carcinoma. 2018;391(10127):1301-14. doi: 10.1016/S0140-6736(18)30010-2.
- Ibrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer incidence in egypt: results of the national population-based cancer registry program. J Cancer Epidemiol. 2014;2014:437971. doi: 10.1155/2014/437971.
- Abd-Elsalam S, Elwan N, Soliman H, Ziada D, Elkhalawany W, Salama M, et al. Epidemiology of liver cancer in Nile delta over a decade: A single-center study. South Asian J Cancer. 2018;7(1):24-26. doi: 10.4103/sajc.sajc_82_17.
- Lau WY, Lai ECH. Hepatocellular carcinoma: current management and recent advances. Hepatobiliary Pancreat Dis Int. 2008;7(3):237–57.
- Yamamoto J, Kosuge T, Saiura A, Sakamoto Y, Shimada K, Sano T,et al. Effectiveness of hepatic resection for early-stage hepatocellular carcinoma in cirrhotic patients: subgroup analysis according to Milan criteria. Jpn J Clin Oncol. 2007;37(4):287-95. doi: 10.1093/jjco/hym025.
- Yamamoto M, Takasaki K, Otsubo T, Katsuragawa H, Katagiri S, Yoshitoshi K, et al. Favorable surgical outcomes in patients with early hepatocellular carcinoma. Ann Surg. 2004;239(3):395-9. doi:1097/01.sla.0000114215.03112.e0.
- Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small epatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693-9.doi: 10.1056/NEJM 199603143341104.
- Lau WY, Leung TW, Yu SC, Ho SK. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg. 2003;237(2):171-9. doi: 10.1097/01.SLA.0000048443.71734.BF.
- Rim CH, Seong J. Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines. Radiat Oncol J. 2016;34(3):160-7. doi: 10.3857/roj.2016.01970.
- Hawkins MA, Dawson LA. Radiation therapy for hepatocellular carcinoma from palliation to cure. Cancer. 2006;106(8):1653-61. doi: 10.1002/cncr.21811.
- Kim TH, Kim DY, Park JW, Kim YI, Kim SH, Park HS, et al. Three-dimensional conformal radiotherapy of unresectable hepatocellular carcinoma patients for whom transcatheter arterial chemoembolization was ineffective or unsuitable. Am J ClinOncol. 2006;29(6):568-75. doi:1097/01.coc.0000239147.60196.11.
- Seong J, Park HC, Han KH, Chon CY. Clinical results and prognostic factors in radiotherapy for unresectable hepatocellular carcinoma: a retrospective study of 158 patients. Int J Radiat Oncol Biol Phys. 2003;55(2):329-36. doi: 10.1016/s0360 -3016(02)03929-9.
- Mornex F, Girard N, Beziat C, Kubas A, Khodri M, Trepo C, et al. Feasibility and efficacy of high-dose three-dimensional-conformal radiotherapy in cirrhotic patients with small-size hepatocellular carcinoma non-eligible for curative therapies–mature results of the French Phase II RTF-1 trial. Int J Radiat Oncol Biol Phys. 2006;66(4):1152-8. doi: 10.1016/j.ijrobp.2006.06.015.
- Park W, Lim DH, Paik SW, Koh KC, Choi MS, Park CK, et al. Local radiotherapy for patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2005;61(4):1143‑50. doi: 10.1016/j.ijrobp.2004.08.028.
- Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).Eur J Cancer. 2009;45(2):228–47. doi: 10.1016/j.ejca.2008.10.026.
- Trotti A, Colevas AD, Setser A, Rusch V, Jaques D, Budach V, et al. CTCAE v3.0: Development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003;13(3):176-81. doi: 10.1016/S1053-4296(03)00031-6.
- Huang BS, Tsang NM, Lin SM, Lin DY, Lien JM, Lin CC, et al. High-dose hypofractionated X-ray radiotherapy for hepatocellular carcinoma: tumor responses and toxicities. Oncol Lett. 2013;6(5):1514-20.doi: 10.3892/ol.2013.1582.
- Oh D, Lim do H, Park HC,Paik SW, Koh KC, Lee JH, 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(4):370-5. doi: 10.1097/COC.0b013e3181b0c298.
- Liu MT, Li SH, Chu TC, Hsieh CY, Wang AY, Chang TH, et al. Three-dimensional conformal radiation therapy for unresectable hepatocellular carcinoma patients who had failed with or were unsuited for transcatheter arterial chemoembolization. Jpn J Clin Oncol. 2004;34(9):532–9. doi: 10.1093/jjco/ hyh089.
- Liang SX, Zhu XD, Lu HJ, Pan CY, Li FX, Huang QF, et al. Hypofractionated three-dimensional conformal radiation therapy for primary liver carcinoma. Cancer. 2005;103(10):2181–8. doi:1002/cncr.21012.
- Seo YS, Kim JN, Keum B, Park S, Kwon YD, Kim YS, Jeen YT, et al. Radiotherapy for 65 patients with advanced unresectable hepatocellular carcinoma. World J Gastroenterol. 2008;14(15):2394–400. doi: 10.3748/wjg.14.2394.
- Bae SH, Park HC, Lim DH, Lee JA, Gwak GY, Choi MS, et al. Salvage treatment with hypofractionated radiotherapy in patients with recurrent small hepatocellularcarcinoma. Int J Radiat Oncol Biol Phys. 2012;82(4):e603‑7. doi: 10.1016/j.ijrobp.2011.09.053.
- Li N, Feng S, Xue J, Wei XB, Shi J, Guo WX, et al. Hepatocellular carcinoma with main portal vein tumor thrombus: a comparative study comparing hepatectomy with or without neoadjuvant radiotherapy. HPB (Oxford). 2016;18(6):549–56. doi: 10.1016/j.hpb.2016.04.003.
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