Local radiotherapy for unresectable hepatocellular carcinoma patients who failed with transcatheter arterial chemoembolization

Purpose: The purpose of this study was to investigate the efficacy of local radiotherapy (RT) as a salvage treatment for unresectable hepatocellular c arcinoma (HCC) patients who failed with transcatheter arterial chemoemboliz ation (TACE), Methods and Materials: Patients with unresectable HCC who had been treated with and eventually failed with TACE were eligible. The judgment of TACE fa ilure was based on incomplete tumor filling of lipiodol-adriamycin mixture on either angiography or computed tomography (CT) scan. From January 1993 t o December 1997, 27 patients were entered into this study, They had UICC St age III (17) or IVA (10) disease, with a mean tumor size of 7.2 +/- 2.9 cm, Local RT was done, with a mean tumor dose of 51.8 +/- 7.9 Gy, in daily 1.8 -Gy fractions using a 10- or 6-MV linear accelerator. Survival was calculat ed from both the diagnosis and the start of RT using the Kaplan-Meier metho d. Results: An objective response was observed in 16 of 24 patients (66.7%) in cluding 1 CR, Intrahepatic metastasis was noted outside the RT field in 10 patients (37.0%), Extrahepatic distant metastasis occurred in 4 patients, S urvival rates at 1, 2, and 3 years were 85.2%, 58.1%, and 33.2%, respective ly, from the diagnosis and 55.9%, 35.7%, and 21.4%, respectively, from the start of RT, The median survivals were 26 months from the diagnosis and 14 months from the start of RT, Acute toxicity involved alteration in liver fu nction test (13 patients) and thrombocytopenia (2 patients), Subacute and c hronic toxicity involved gastroduodenal ulcer (3 patients) and duodenitis ( 2 patients). There was no treatment-related death. Conclusion: In unresectable HCC patients who failed with TACE, local RT ind uced a substantial tumor response of 66.7%, with a 3-year survival rate of 21.4% and a median survival time of 14 months, Toxicity was significant but manageable, Although we do not know if there is survival benefit through t his treatment, local RT in these patients seems to be valuable as a salvage for TACE-failed HCC, (C) 2000 Elsevier Science Inc.