A comparison of chemoembolization combination with and without radiotherapy for unresectable hepatocellular carcinoma.
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.
Zeng
Zhao-Chong
ZC
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China. zcheng@zshospital.net
Tang
Zhao-You
ZY
Fan
Jia
J
Zhou
Jian
J
Qin
Lun-Xiu
LX
Ye
Shen-Long
SL
Sun
Hui-Chuan
HC
Wang
Bin-Liang
BL
Yu
Yao
Y
Wang
Jian-Hua
JH
Guo
Wei
W
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
D003287:Contrast Media; D000509:alpha-Fetoproteins; D016685:Mitomycin; D007459:Iodized Oil; D005723:gamma-Glutamyltransferase; D002945:Cisplatin; D005472:Fluorouracil