A pilot study of three-dimensional conformal radiotherapy in unresectable hepatocellular carcinoma

Background: The purpose of this study was to determine the potential role o f three-dimensional (3-D) conformal radiotherapy (RT) in treatment of unres ectable hepatocellular carcinoma (HCC). Methods: Thirteen patients were included in this study, which was conducted between 1993 and 1996. Nine patients (group A) were treated with 3-D confo rmal RT alone because of main portal vein thrombosis, inferior vena cava th rombosis, obstructive jaundice and failure of previous transcatheter arteri al chemoembolization (TACE) to control the disease. The remaining four pati ents (group B) were treated with a combination of TACE and 3-D conformal RT . Results: The greatest dimension of the main tumour in the whole group of pa tients ranged from 6 to 25 cm (median 15 cm). The radiation dose ranged fro m 40 to 60 Gy. The tumour response was evaluated by computed tomography sca ns of the liver 6-8 weeks after completion of radiotherapy. Partial respons e was observed in 58% of the patients (seven of 12) and minimal response in another 25% of patients (three of 12). One patient could not be evaluated because of the development of hepatic failure 1 month after completion of R T. All patients in group B lived for more than 1 year (range 16-40 months). In group A, one patient who had a large tumour (11 x 10 x 21 cm) with port al vein thrombosis was converted to become resectable after 45 Gy of radiat ion. The resection specimen revealed no residual cancer cells. This patient is alive longer than 15 months after treatment without the evidence of dis ease. Conclusions: Our experience indicates that HCC is more radiosensitive than it was traditionally expected. Three-dimensional reconstruction of tumour a nd surrounding organs helps to avoid excessive exposure of the liver and ad jacent organs to RT and makes it a safer treatment modality for unresectabl e HCC. Our preliminary data show promise and are worthy of further study to explore the potential role of radiotherapy in the treatment strategy for H CC at various stages of involvement. (C) 1999 Blackwell Science Asia Pty Lt d.