Dose escalation by intensity modulated radiotherapy in liver-directed concurrent chemoradiotherapy for locally advanced BCLC stage C hepatocellular carcinoma
- Authors
- Byun, Hwa Kyung; Kim, Hyun Ju; Im, Yoo Ri; Kim, Do Young; Han, Kwang-Hyub; Seong, Jinsil
- Issue Date
- Apr-2019
- Publisher
- ELSEVIER IRELAND LTD
- Keywords
- Hepatocellular carcinoma; Radiation dose-response relationship; Intensity modulated radiotherapy; Hepatic arterial infusion chemotherapy
- Citation
- RADIOTHERAPY AND ONCOLOGY, v.133, pp.1 - 8
- Journal Title
- RADIOTHERAPY AND ONCOLOGY
- Volume
- 133
- Start Page
- 1
- End Page
- 8
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/1619
- DOI
- 10.1016/j.radonc.2018.12.025
- ISSN
- 0167-8140
- Abstract
- Purpose: To evaluate the effects of dose escalation by intensity-modulated radiotherapy (IMRT) in liverdirected concurrent chemoradiotherapy for locally advanced Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma (BCLC-C HCC). Materials and methods: During 2005-2016, 637 patients with BCLC-C HCC received RT with concurrent hepatic arterial 5-fluorouracil. Patients were divided into two groups according to the biologically effective doses for a tumor (alpha/beta = 10 Gy): < 72 Gy (536 patients) and >= 72 Gy (101 patients). In each group, 128/536 (24%) and 94/101 patients (93%) used IMRT, respectively. Results: The median follow-up for patients alive at the time of analysis was 36 months (range, 6-159 months). For >= 72 Gy and < 72 Gy groups, the median overall survival (OS) was 21 and 13 months, respectively (P =.002). The 1-year local failure-free survival (LFFS) were significantly higher in high-dose group (95% vs. 79%; P <.001). After propensity score matching, high-dose group still had significantly better 1-year OS (62% vs. 51%; P =.03) and 1-year LFFS (95% vs. 78%; P =.008). In the multivariate model, RT dose was an independent predictor of LFFS and OS. The surgical conversion rate was significantly higher in high-dose group (20% vs. 12%, P =.03), with substantially increased median OS among patients who underwent surgery (104 months vs. 11 months; P <.001). There were no significant differences in gastrointestinal bleeding or radiation-induced liver disease. Conclusions: In liver-directed concurrent chemoradiotherapy, radiation dose escalation by IMRT increased LFFS and OS for locally advanced BCLC-C HCC. It also increased the conversion rate to curative resection, which was attributable to increased OS. (C) 2018 Elsevier B.V. All rights reserved.
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