Abstract

Purpose

External beam radiotherapy (EBRT) has been commonly applied as salvage or a combination locoregional modality after transarterial chemoembolization (TACE) for hepatocellular carcinomas (HCCs). This study reports oncologic outcomes and feasibility after application of the two modalities in our center.

Methods

Forty consecutive patients who underwent EBRT due to incomplete responses of TACE were evaluated. Fourteen patients (35.0%) received stereotactic body radiotherapy (SBRT) and the remaining patients received conventionally fractionated radiotherapy (RT). A majority of patients who underwent SBRT received doses of 27 to 48 Gy in 3–4 fractions [median EQD₂ (Equivalent dose in 2 Gy per fraction radiotherapy): 57.0 Gy]. Conventionally fractionated RT was performed with a median EQD₂ of 47.8 Gy.

Results

The median follow-up duration was 14.4 months (range: 2.6–83.0 months). A majority (77.5%) of patients were regarded as having Child-Pugh grade A. The median tumor size was 3.4 cm (range: 0.8–20.1 cm). Ten patients (25.0%) had thrombosis at a main portal branch. The 1- and 2-year overall survival (OS) and progression-free survival (PFS) rates were 82.2% and 42.1% and 55.8% and 32.1%, respectively. The local control rates were 89.1% and 89.1% at 1 and 2 years, respectively. The albumin level was a significant factor affecting OS (p = .002), and the BCLC stage significantly affected PFS (p = .001). Intrahepatic, out-of-field recurrence was the main cause of disease progression (60.0%), and distant metastasis developed in 12 patients (30.0%) during follow-up. Non-classic radiation-induced liver disease was seen in five (12.5%) patients, and two (5%) patients experienced grade ≥3 hepatic toxicities.

Conclusions

EBRT after incomplete TACE was feasible and yielded favorable oncologic outcomes. However, disease progression related to intrahepatic failure remained a hindrance.

中文翻译：

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外束放射疗法配合不完全性动脉化疗栓塞治疗肝细胞癌的临床疗效

摘要

目的

对于肝细胞癌（HCC），经体外化学放射栓塞（TACE）后，外部束放射疗法（EBRT）通常被用作抢救或局部区域联合疗法。这项研究报告了在我们中心应用两种方式后的肿瘤学结果和可行性。

方法

评估了40位因TACE反应不完全而接受EBRT的连续患者。14例患者（35.0％）接受了立体定向放射治疗（SBRT），其余患者接受常规分次放射治疗（RT）。大多数接受SBRT的患者分3至4次接受27至48 Gy的剂量[中位数EQD ₂（每级放疗2 Gy的等效剂量）：57.0 Gy]。常规分馏RT的平均EQD ₂为47.8 Gy。

结果

中位随访时间为14.4个月（范围：2.6-83.0个月）。大部分（77.5％）患者被认为患有Child-Pugh A级。中位肿瘤大小为3.4厘米（范围：0.8–20.1厘米）。十名患者（25.0％）在主要门静脉分支处有血栓形成。1年和2年总生存率（OS）和无进展生存率（PFS）分别为82.2％和42.1％，55.8％和32.1％。在1年和2年时，本地控制率分别为89.1％和89.1％。白蛋白水平是影响OS的重要因素（p  = .002），而BCLC阶段显着影响PFS（p = .001）。肝内，场外复发是疾病进展的主要原因（60.0％），在随访期间有12例患者（30.0％）发生远处转移。在五名（12.5％）患者中发现了非经典的辐射诱发性肝病，其中两名（5％）患者经历了≥3级肝毒性。

结论

TACE不完全后的EBRT是可行的，并产生了良好的肿瘤学结局。然而，与肝内衰竭相关的疾病进展仍然是一个障碍。