title: Concurrent chemoradiotherapy shows long-term survival after conversion from locally advanced to resectable hepatocellular carcinoma.
abstract: OBJECTIVE
  For locally unresectable hepatocellular carcinoma (HCC) patients, concurrent chemoradiotherapy (CCRT) has been applied as a loco-regional treatment. After shrinkage of tumors in selected patients, surgical resection is performed. The aim of this study was to evaluate prognostic factors and long-term survivors in such patients.
  
  
  METHODS
  From January 2000 to January 2009, 264 patients with HCC were treated with CCRT (45 Gy with fractional dose of 1.8 Gy), and intra-arterial chemotherapy was administered during radiotherapy. Eighteen of these patients (6.8%) underwent hepatic resection after showing a response to CCRT. Cases were considered resectable when tumor-free margins and sufficient remnant volumes were obtained without extrahepatic metastasis. Prior to operation, there were six patients with complete remission, 11 with partial remission, and six with stable disease according to modified Response Evaluation Criteria in Solid Tumors.
  
  
  RESULTS
  In pathologic review, four patients (22.2%) showed total necrosis and seven patients (38.9%) showed 70-99% necrosis. A high level of necrosis (≥80%) was correlated with low risk for extrahepatic metastasis and long-term survival. In univariate analyses, vessel invasion and capsular infiltration were significantly correlated with disease free survival (DFS) (p=0.017 and 0.013, respectively), and vessel invasion was significantly correlated with overall survival (OS) (p=0.013). In multivariate analyses, capsule infiltration was a significant factor for DFS (p=0.016) and vessel invasion was significant for OS (p=0.015).
  
  
  CONCLUSIONS
  CCRT showed favorable responses and locally advanced HCC converted into resectable tumor after CCRT in selected patients. Long-term survivors showed the pathological features of near total necrosis, as well as negative capsule and vessel invasion.
authors.affiliation: Department of Radiation Oncology, Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ik Jae
authors.initials: IJ
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jun Won
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kwang Hyub
authors.initials: KH
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ja Kyung
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Department of Pathology, Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Nyun
authors.initials: YN
authors.lastname: Park
authors.affiliation: Department of Radiation Oncology, Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea. jsseong@yuhs.ac.
authors.forename: Jinsil
authors.initials: J
authors.lastname: Seong
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020266:Radiotherapy, Conformal; D012074:Remission Induction; D056910:Republic of Korea / Q000453:epidemiology; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D002945:Cisplatin; D005472:Fluorouracil
keywords: Hepatocellular carcinoma; concurrent chemoradiotherapy; hepatic resection; intra-arterial chemotherapy