title: Radiation therapy for intrahepatic recurrence after hepatectomy for hepatocellular carcinoma.
abstract: BACKGROUND
  The intrahepatic recurrence rate after curative hepatectomy for hepatocellular carcinoma (HCC) is high, and management of recurrence is thus important for long-term survival. The use of radiation therapy has been relatively uncommon in the treatment of recurrent HCC.
  
  
  METHODS
  Eight patients underwent radiation therapy for recurrent HCC 12-98 months after hepatectomy. Five of them were treated with protons (250 MeV; 68.8-84.5 Gy), and three were treated with X-rays (6 MV; 60 or 70 Gy). One patient received radiation therapy twice for another lesion with a 79-month interval. The target tumors were 1.2-4.5 cm. All patients also underwent transcatheter arterial embolization or other regional therapy.
  
  
  RESULTS
  Although transient ascites was found in three patients after radiation therapy, no patient died as a result of the irradiation. Seven patients died 9 months to 4 years (median 1 year 6 months) after radiation therapy. Re-recurrence was observed in the irradiated liver in two patients (local control 78%). Four patients died of lung metastasis after radiation therapy. The median survival time was 3 years 3 months (range 1 year 1 month to 8 years 6 months) after recurrence.
  
  
  CONCLUSIONS
  Multimodality therapy is necessary for the management of recurrence. Radiation therapy could be beneficial when other therapies present some difficulty regarding application or are performed incompletely. It must be emphasized that radiation therapy should be considered in addition to other regional therapies for the treatment of recurrent or re-recurrent HCC, and that radiation therapy can be repeated in selected patients.
authors.affiliation: Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Otsuka
authors.forename: Kiyosi
authors.initials: K
authors.lastname: Ohara
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Takanori
authors.initials: T
authors.lastname: Ueda
authors.forename: Souichirou
authors.initials: S
authors.lastname: Murata
authors.forename: Ryou
authors.initials: R
authors.lastname: Ushijima
authors.forename: Shinya
authors.initials: S
authors.lastname: Adachi
authors.forename: Takesi
authors.initials: T
authors.lastname: Todoroki
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D001918:Brachytherapy / Q000379:methods; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011829:Radiation Dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D016019:Survival Analysis; D016896:Treatment Outcome