Radioresponse of hepatocellular carcinoma-treatment of lymph node metastasis.
OBJECTIVE
To analyze the radioresponse of hepatocellular carcinomas (HCC), using accurate measurements of the tumor size in extrahepatic lymph node metastasis, and to obtain information for the future treatment of primary intrahepatic lesions.


METHODS
Fifty-one extrahepatic lymph node metastases from primary HCCs, which could be treated by external radiotherapy alone, were included in this study. The radiation dose ranged from 30 to 51 Gy with fraction sizes of 2.0 approximately 3.0 Gy. Responses were determined by measuring the areas on CT scans 0, 1 and 3 months after the completion of radiotherapy. The median follow-up period of the surviving patients was 10 months.


RESULTS
The overall response rate was 76%, and the important factors were; total dose of radiation, time dose fractionation (TDF) value and the biologically effective dose (BED). A dose of 45 Gy or higher showed an objective response rate of 93%, and if the TDF value was higher than 90, a similar result was observed. In about half (47%) of the patients the maximum response was observed at 3 months or later. The response duration was observable in 14 patients surviving 12 months or longer. Regrowth of irradiated lesions were observed in 4 (66.7%) patients among those who received less than 45 Gy, and in 4 (50%) among those who were treated with 45 Gy or more. There was a statistically significant difference in the survivals between the responders and non-responders (p=0.008). Gastrointestinal bleeding or ulceration was observed in 8 patients, including 3 with NCI common toxicity criteria grade III or higher.


CONCLUSIONS
Radiotherapy was an effective palliative modality for extrahepatic metastasis in HCCs. A radiation dose of 45 Gy or higher (or a TDF value >or=90), was required for a major response.
Yoon
Sang Min
SM
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Kim
Jong Hoon
JH
Choi
Eun Kyung
EK
Ahn
Seung Do
SD
Lee
Sang-wook
SW
Yi
Byong Yong
BY
Chung
Young Wha
YW
Lee
Young Sang
YS
Seo
Dong Jin
DJ
Am J Surg. 1997 Apr;173(4):358-65
9136797
Int J Radiat Oncol Biol Phys. 2000 Apr 1;47(1):13-47
10758303
Br J Radiol. 2000 Oct;73(874):1091-7
11271902
Int J Radiat Oncol Biol Phys. 1997 Dec 1;39(5):1077-85
9392547
Int J Radiat Oncol Biol Phys. 1991 Jan;20(1):65-71
1847127
Int J Radiat Oncol Biol Phys. 2000 Jul 15;47(5):1331-5
10889387
Int J Radiat Oncol Biol Phys. 1991 May 15;21(1):109-22
2032882
Am J Gastroenterol. 1998 Nov;93(11):2167-71
9820391
Hepatogastroenterology. 1998 May-Jun;45(21):791-6
9684136
Nihon Igaku Hoshasen Gakkai Zasshi. 1989 Sep 25;49(9):1141-51
2555769
Gastroenterology. 1994 Apr;106(4):1032-41
7511552
Lancet. 1992 Aug 1;340(8814):285-8
1353202
Ann Surg. 1994 Mar;219(3):236-47
8147605
Int J Radiat Oncol Biol Phys. 1997 Jan 15;37(2):325-30
9069303