Hypofractionated three-dimensional conformal radiation therapy for primary liver carcinoma.
BACKGROUND
The purpose of the current study was to evaluate the tolerance and efficacy of hypofractionated three-dimensional conformal radiotherapy (3DCRT) with or without transarterial chemoembolization (TACE) for technically unresectable or medically inoperable primary liver carcinoma (PLC).


METHODS
Between April 1999 and August 2003, 128 patients with a clinical diagnosis of PLC received hypofractionated 3DCRT at Cancer Hospital, Guangxi Medical University. Both hypofractionated 3DCRT and TACE were used to treat 48 of these 128 patients. Liver cirrhosis of Child-Pugh Grade A was found in 108 patients, and Grade B was found in 20 patients. The mean gross tumor volume (GTV) was 459 +/- 430 cm3. A mean total irradiation dose of 53.6 +/- 6.6 Gy was delivered at an average fraction of 4.88 +/- 0.47 Gy, 3 times a week using 8-MV photons.


RESULTS
The median follow-up time after 3DCRT was 12 months (range, 2-56 mos.). The immediate response rate was 55%. The overall survival rates at 1, 2, and 3 years were 65%, 43%, and 33%, respectively, with a median survival of 20 months (range, 7-31 mos.). Radiation Therapy Oncology Group (RTOG) Grade 2 acute gastrointestinal complications developed in 8 patients, whereas 4 patients developed Grade 3 late gastrointestinal complications. Radiation-induced liver disease (RILD) developed in 19 (15%) patients, of which 12 had Child-Pugh Grade B liver cirrhosis, and 7 had Grade A. GTV and associated liver cirrhosis were identified by Cox regression analysis as independent predictors for survival (P = 0.044 and 0.015).


CONCLUSIONS
Hypofractionated 3DCRT is effective in carefully selected patients with PLC. Gastrointestinal complications and RILD were the most distinct complications.
Liang
Shi-Xiong
SX
Department of Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
Zhu
Xiao-Dong
XD
Lu
Hai-Jie
HJ
Pan
Chao-Yang
CY
Li
Fu-Xiang
FX
Huang
Qi-Fang
QF
Wang
An-Yu
AY
Chen
Long
L
Fu
Xiao-Long
XL
Jiang
Guo-Liang
GL
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002277:Carcinoma / Q000532:radiotherapy* / Q000556:secondary / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D005759:Gastroenteritis / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology; D008107:Liver Diseases / Q000209:etiology; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology; D011836:Radiation Tolerance; D020266:Radiotherapy, Conformal / Q000379:methods*; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome