title: A comparison of chemoembolization combination with and without radiotherapy for unresectable hepatocellular carcinoma.
abstract: OBJECTIVE
  This study evaluated the effect of transcatheter arterial chem-oembolization combined with external beam radiotherapy on the response rates and sur vival of patients with unresectable hepato-cellular carcinoma. Transcatheter arterial chemoembolization is frequently used for the treatment of this cancer, but complete or massive necrosis is seldom observed. Historically, radiotherapy for hepatocellular carcinoma has yielded poor long-term survival. Multimodality therapy has been initiated in an effort to improve survival statistics.
  
  
  METHODS
  We retrospectively studied 203 patients with unresectable hepa-tocellular carcinoma, who were free of tumor thrombus, lymph node involvement, or extrahepatic metastasis based on computed tomography scans of the chest and abdomen. Among the 203 patients who received transcatheter ar terial chemoembolization as initial therapy, 54 also received combination therapy with external beam radiotherapy. Tumor response rate, survival, and failure patterns were analyzed and compared between the two groups.
  
  
  RESULTS
  Objective responses (complete and partial responses) on computed tomography study were obser ved in 31% and 76% of patients in the non-radiotherapy and radiotherapy groups, respectively. Overall survival rates in the patients in the radiotherapy group were 71.5%, 42.3%, and 24.0% at 1, 2, and 3 years, respectively, improved over the non-radiotherapy group rates of 59.6%, 26.5%, and 11.1% at 1, 2, and 3 years, respectively. Intrahepatic failure was lower in the radiotherapy group than in the non-radiotherapy group, but the difference was not significant. Side effects from radiotherapy were common, but rarely severe.
  
  
  CONCLUSIONS
  This retrospective study suggests that the outcome of unresectable hepatocellular carcinoma can be influenced by radiation therapy, but a prospective randomized trial would be necessary to draw definitive conclusions.
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China. zcheng@zshospital.net
authors.forename: Zhao-Chong
authors.initials: ZC
authors.lastname: Zeng
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.forename: Lun-Xiu
authors.initials: LX
authors.lastname: Qin
authors.forename: Shen-Long
authors.initials: SL
authors.lastname: Ye
authors.forename: Hui-Chuan
authors.initials: HC
authors.lastname: Sun
authors.forename: Bin-Liang
authors.initials: BL
authors.lastname: Wang
authors.forename: Yao
authors.initials: Y
authors.lastname: Yu
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage / Q000009:adverse effects; D017093:Liver Failure / Q000453:epidemiology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects; D015999:Multivariate Analysis; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D003287:Contrast Media; D000509:alpha-Fetoproteins; D016685:Mitomycin; D007459:Iodized Oil; D005723:gamma-Glutamyltransferase; D002945:Cisplatin; D005472:Fluorouracil