title: Clinical study of transarterial chemoembolization combined with 3-dimensional conformal radiotherapy for hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Monotherapy is not very effective for intermediate or advanced stage HCC. Efficacy of combined therapy using transarterial chemoembolization (TACE) with three-dimensional conformal radiotherapy (3-DCRT) for advanced HCC should be evaluated.
  
  
  METHODS
  HCC patients were selected from our patient database. The sequence of treatments that patients underwent was several courses of TACE followed in 2-4 weeks by 3-DCRT. The median tumor irradiation dose was 44Gy. Toxicity, tumor response, and overall survival rate were analyzed.
  
  
  RESULTS
  140 HCC patients were followed up by the last follow-up time. Among these patients, hepatic toxicities due to treatment were notable in 15 cases. Gastrointestinal bleeding after the overall treatment occurred in 3 cases. Leukopenia of grade III was detected in 1 case. Radiation-induced liver disease (RILD) was observed in 3 patients. Among 140 patients, 27, 97, and 16 cases achieved partial response, stable disease, and progressive disease, respectively. The overall survival rates of 1-year, 3-years, and 5-years were 66%, 29%, and 13%, respectively, with a median survival time of 18 months. Both Child-Pugh grade and radiation dose were determined to be independent predictors for overall survival from multivariate analysis.
  
  
  CONCLUSIONS
  The combined modality of TACE and 3-DCRT is a promising treatment for unresectable HCC. A large-scale, prospective randomized trial should be performed to confirm the utility of this combined therapy.
authors.affiliation: Department of Oncology, Shanghai Medical College, Fudan University, China.
authors.forename: L-T
authors.initials: LT
authors.lastname: Xu
authors.forename: Z-H
authors.initials: ZH
authors.lastname: Zhou
authors.forename: J-H
authors.initials: JH
authors.lastname: Lin
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
authors.forename: K
authors.initials: K
authors.lastname: Wang
authors.forename: P
authors.initials: P
authors.lastname: Wang
authors.forename: X-Y
authors.initials: XY
authors.lastname: Zhu
authors.forename: Y-H
authors.initials: YH
authors.lastname: Shen
authors.forename: Z-Q
authors.initials: ZQ
authors.lastname: Meng
authors.forename: L-M
authors.initials: LM
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D020266:Radiotherapy, Conformal / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome