title: Absence of symptom and intact liver function are positive prognosticators for patients undergoing radiotherapy for lymph node metastasis from hepatocellular carcinoma.
abstract: OBJECTIVE
  The positive role of radiotherapy for patients with lymph node (LN) metastasis from hepatocellular carcinoma has recently been reported. The outcome and prognostic factors for these patients were analyzed.
  
  
  METHODS
  Between May 2004 and October 2007, 38 patients with LN metastases from hepatocellular carcinoma underwent radiotherapy. The median age was 59 years (range, 42-81). The radiation dose was 35-56 Gy with a fraction size of 1.8-3 Gy, for a biologically effective dose of 43.75-67.2 Gy(10) (median, 59.0). The median follow-up period was 8 months.
  
  
  RESULTS
  The median survival time was 10 months. On univariate analysis, Child-Pugh class B (p = .0006), distant metastasis (p = .0095), symptoms related to metastatic LNs (p <.0001), and a biologically effective dose <60 Gy(10) (p = .0042) were significant prognostic factors predicting for poor overall survival. On multivariate analysis after adjustment using the Benjamini and Hochberg (false discovery rate) method, Child-Pugh class B (p = .04095) and the presence of symptoms (p = .04095) were associated with inferior overall survival. When patients were divided into three groups according to these two risk factors, the median survival for patients with no, either, or both risk factors was 20, 7, and 4 months, respectively (p <.0001).
  
  
  CONCLUSIONS
  Patients with intact liver function and without related symptoms had the best prognosis when undergoing radiotherapy for LN metastasis from hepatocellular carcinoma.
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyubo
authors.initials: K
authors.lastname: Kim
authors.forename: Eui Kyu
authors.initials: EK
authors.lastname: Chie
authors.forename: Won
authors.initials: W
authors.lastname: Kim
authors.forename: Yoon Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jung Hwan
authors.initials: JH
authors.lastname: Yoon
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Lee
authors.forename: Sung W
authors.initials: SW
authors.lastname: Ha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D006801:Humans; D008099:Liver / Q000502:physiology*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012062:Relative Biological Effectiveness; D012074:Remission Induction; D015996:Survival Rate; D047368:Tumor Burden