Radiation therapy for the locoregional lymph node metastases from hepatocellular carcinoma, phase I clinical trial.
OBJECTIVE
The patients with lymph node metastasis from hepatocellular carcinoma may survive only a few months. These patients are not suitable for transcatheter arterial chemoembolization, percutaneous ethanol injection and surgical resection. External beam radiation therapy (EBRT) could provide a useful treatment, but only 4 hepatocellular carcinoma cases with abdominal lymph nodes involvement were treated with EBRT in the two reports over the last 10 years. In this paper, we report 29 hepatocellular carcinoma patients with abdominal lymph node metastasis who received EBRT over a period of 5 years.


METHODS
Of 29 patients, 20 were pathologically confirmed to have hepatocellular carcinoma and 9 patients were clinically diagnosed to have hepatocellular carcinoma. All of the patients had proven abdominal lymph node metastasis by enhanced abdominal computer tomography scan due to clinical follow-up or abdominal symptoms. EBRT was not the initial treatment in all. The patients received locoregional lymph nodes irradiation. The tumor dose ranged from 30 to 60 Grays (Gy) in daily 2.0-Gy fractions (Fx), 5 times a week.


RESULTS
It is of interest to note that an objective regression (complete response and partial response) rate was 100%. The clinical symptoms were relieved. The median survival time was 8 (4-28) months. The overall 1-year and 2-year survival rates were 43.5% and 10.5%, respectively. The median survival time consistently decreased as the lymph node involvement increase follows the natural flow of lymph.


CONCLUSIONS
Lymph node metastasis from hepatocellular carcinoma is sensitive to EBRT, although EBRT is palliative in intent, it is useful in the treatment with 50 Gy/25 Fx for those patients.
Zeng
Zhao-Chong
ZC
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China. Zengzhaochong@yahoo.com
Tang
Zhao-You
ZY
Yang
Bing-Hui
BH
Fan
Jia
J
Qin
Lun-Xiu
LX
Jiang
Guo-Liang
GL
Zhou
Jian
J
Sun
Hui-Chuan
HC
Cheng
Jie-Min
JM
Wang
Jian-Hua
JH
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000556:secondary*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011879:Radiotherapy Dosage