Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05)
- Author:
Sun Hyun BAE
1
;
Hee Chul PARK
;
Won Sup YOON
;
Sang Min YOON
;
In Hye JUNG
;
Ik Jae LEE
;
Jun Won KIM
;
Jinsil SEONG
;
Tae Hyun KIM
;
Taek Keun NAM
;
Youngmin CHOI
;
Sun Young LEE
;
Hong Seok JANG
;
Dong Soo LEE
;
Jin Hee KIM
Author Information
- Publication Type:Original Article
- Keywords: Child-Pugh B; Hepatocellular carcinoma; Hepatic toxicity; Radiotherapy
- MeSH: Carcinoma, Hepatocellular; Classification; Disease-Free Survival; Humans; Korea; Liver; Liver Diseases; Multivariate Analysis; Portal Vein; Radiotherapy; Radiotherapy, Conformal; Retrospective Studies; Thrombosis; Treatment Outcome
- From:Cancer Research and Treatment 2019;51(4):1589-1599
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B. MATERIALS AND METHODS: We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologically effective dose (BED) ≥ 40 Gy₁₀ (α/β = 10 Gy). A total of 184 patients were included in this study. RESULTS: Initial CP score was seven in 62.0% of patients, eight in 31.0%, and nine in 7.0%. Portal vein tumor thrombosis was present in 66.3% of patients. The BED ranged from 40.4 to 89.6 Gy₁₀ (median, 56.0 Gy₁₀). After RT completion, 48.4% of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9% and 39.8%, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7% experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD. CONCLUSION: Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.
