title: The Degree of Lipiodol Accumulation Can Be an Indicator of Successful Treatment for Unresectable Hepatocellular Carcinoma (HCC) Patients - in the Case of Transcatheter Arterial Chemoembolization (TACE) and External Beam Radiotherapy (EBRT).
abstract: OBJECTIVE
  Transcatheter arterial chemoembolization (TACE) in combination with external beam radiotherapy (EBRT) results in improved survival due to better local control in patients with unresectable hepatocellular carcinoma (HCC). The purpose of this study was to investigate lipiodol accumulation, as it reflects tumor burden and is a potential prognostic factor, in HCC patients treated with TACE/EBRT.
  
  
  METHODS
  We retrospectively studied 147 patients with unresectable HCC treated with TACE and EBRT. Clinical features, adverse reactions, and prognostic factors were analyzed. All patients were treated with TACE 1-6 times in combination with EBRT (44-66 Gy) in dose of 2 Gy/fraction given once a day five times a week. Tumor status and laboratory findings were followed. The degree of lipiodol accumulation was assessed by computed tomography before EBRT, and was categorized as either complete/intense or low/moderate.
  
  
  RESULTS
  The response rate of tumor size after EBRT was 68.2%, median survival was 23.1 months, and overall survival rates were 86.6%, 49.2%, and 28.2% at 1, 2, and 3 years, respectively. Univariate analysis showed that lower hemoglobin levels, higher alkaline phosphatase levels, Child-Pugh B, negative alpha-fetoprotein (AFP) response after EBRT, poor treatment response after EBRT, tumor diameter >10 cm, and poor lipiodol accumulation were unfavorable prognostic factors. On multivariate analysis, higher hemoglobin levels, Child-Pugh A, decreased AFP levels after treatment, Helical Tomotherapy (HT) and intense lipiodol accumulation after TACE were significant favorable predictors.
  
  
  CONCLUSIONS
  The degree of lipiodol accumulation before EBRT is a prognostic factor in patients with unresectable HCC. Increased AFP levels after EBRT are always associated with poor survival. HT is recommended as a potentially better EBRT modality than three-dimensional conformal radiation therapy (3D-CRT).
authors.affiliation: 1. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Yang
authors.affiliation: 1. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Zhao-Chong
authors.initials: ZC
authors.lastname: Zeng
authors.affiliation: 1. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Bin-Liang
authors.initials: BL
authors.lastname: Wang
authors.affiliation: 1. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Jian-Ying
authors.initials: JY
authors.lastname: Zhang
authors.affiliation: 2. Department of Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.affiliation: 2. Department of Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.affiliation: 1. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Hu
keywords: External beam radiation therapy (EBRT); hepatocellular carcinoma (HCC); lipiodol accumulation.; transcatheter arterial chemoembolization (TACE)