title: High-dose hypofractionated X-ray radiotherapy for hepatocellular carcinoma: Tumor responses and toxicities.
abstract: Hypofractionated radiotherapy (RT) has been employed to treat hepatocellular carcinoma (HCC). The present study aimed to report the treatment effects, the dose-response associations and the factors that are associated with radiation-induced liver disease (RILD) in a high-dose hypofractionated RT procedure. A total of 40 patients with non-metastatic HCC who underwent RT for local control of irradiated tumors were studied. The treatment technique was that of three-dimensional conformal or intensity-modulated radiation therapy, with a fraction size of 3 Gy and a total dose of 40-66 Gy in 14-23 fractions. The biologically-effective dose (BED) was 52.0-85.8 Gy10(median, 74.1 Gy10). Tumor regression was observed in 28 patients (70.0%) with a complete response, partial response, stable disease and progressive disease status in 11 (27.5%), 17 (42.5%), five (12.5%) and seven patients (17.5%), respectively. The one-, two- and five-year overall survival (OS) and in-field control (IFC) rates were 60, 40 and 21% and 73, 62 and 56%, respectively. A positive correlation also emerged between the radiation dose and the IFC (P=0.035). Eight of the 40 patients (20%) developed non-classic RILD. A higher Cancer of the Liver Italian Program score was associated with a higher probability of non-classic RILD (P=0.02). The tumor response and IFC rate of HCC following irradiation were significantly dose-dependent. High-dose hypofractionated X-ray RT is a feasible and effective treatment for HCC in patients with good liver function and for those who meet the criteria for a curative attempt.
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan ; Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Bing-Shen
authors.initials: BS
authors.lastname: Huang
authors.forename: Ngan-Ming
authors.initials: NM
authors.lastname: Tsang
authors.forename: Shi-Ming
authors.initials: SM
authors.lastname: Lin
authors.forename: Deng-Yn
authors.initials: DY
authors.lastname: Lin
authors.forename: Jau-Min
authors.initials: JM
authors.lastname: Lien
authors.forename: Chen-Chun
authors.initials: CC
authors.lastname: Lin
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Chen
authors.forename: Wan-Yu
authors.initials: WY
authors.lastname: Chen
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Hong
keywords: hepatocellular carcinoma; hypofractionated; radiotherapy; toxicities