title: Is local radiotherapy still valuable for patients with multiple intrahepatic hepatocellular carcinomas?
abstract: OBJECTIVE
  To investigate whether local radiotherapy (RT) is valuable for patients with multiple hepatocellular carcinomas (HCCs).
  
  
  METHODS
  From July 1992 to August 2006, 107 patients with unresectable HCC were treated with local RT after incomplete transcatheter arterial chemoembolization (TACE). The RT field included a main tumor with or without other tumor nodules, depending on the effectiveness of TACE. The median RT dose was 50.4 Gy in conventional fractionation. Patients were categorized into four groups: Group 1, single tumor (39 patients); Group 2, multiple tumors within the RT field (25 patients); Group 3, controlled tumors out of the RT field (19 patients); and Group 4, tumors that remained viable out of the RT field (24 patients).
  
  
  RESULTS
  Group 1 showed the best survival rate (MST, 35 months; 2-year OS, 60%) and Group 4 the worst (MST, 5 months; 2-year OS, 16%). Group 2 and Group 3 showed similar survival (MST, 13 vs. 19 months; 2-year OS, 35% vs. 46%; p = 0.698). Significantly worse intrahepatic control in Group 4 was observed. The survival in Groups 2 and 3 (MST, 16 months) was significantly different from that in Group 4 (p = 0.004), and was marginally significant compared with that in Group 1 (p = 0.051).
  
  
  CONCLUSIONS
  Local RT to the main tumor could be applicable in well-controlled intrahepatic tumors out of the RT field. Patients with viable intrahepatic tumors out of the RT field showed worse survival. In future clinical trials, these patients need to be excluded.
authors.affiliation: Department of Radiation Oncology, Yonsei Liver Cancer Special Clinic, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Woong Sub
authors.initials: WS
authors.lastname: Koom
authors.forename: Jinsil
authors.initials: J
authors.lastname: Seong
authors.forename: Kwang Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Do Yun
authors.initials: DY
authors.lastname: Lee
authors.forename: Jong Tae
authors.initials: JT
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D016461:Chemoembolization, Therapeutic / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012074:Remission Induction; D015996:Survival Rate; D047368:Tumor Burden