Combined therapy of transcatheter arterial chemoembolisation and three-dimensional conformal radiotherapy for hepatocellular carcinoma

• Published in: British journal of radiology 2007-03, Vol.80 (951), p.194-201
• Main Authors: ZHOU, Z.-H, LIU, L.-M, CHEN, W.-W, MEN, Z.-Q, LIN, J.-H, CHEN, Z, ZHANG, X.-J, JIANG, G.-L
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - radiotherapy; Carcinoma, Hepatocellular - secondary; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic - adverse effects; Chemoembolization, Therapeutic - methods; Combined Modality Therapy; Epidemiologic Methods; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hematologic and hematopoietic diseases; Humans; Liver Neoplasms - pathology; Liver Neoplasms - radiotherapy; Liver Neoplasms - therapy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Neoplasm Staging; Other diseases. Hematologic involvement in other diseases; Other diseases. Semiology; Prognosis; Radiation Injuries - etiology; Radiotherapy, Conformal - adverse effects; Radiotherapy, Conformal - methods; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Treatment Outcome; Tumors
• ISSN: 0007-1285; 1748-880X
• DOI: 10.1259/bjr/33521596

To evaluate the toxicity and efficacy of combined therapy of three-dimensional conformal radiotherapy (3DCRT) and transcatheter arterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC). 50 HCC patients treated by combined TACE and 3DCRT were selected from a patient database. Sequence of treatments was that TACE was performed first, followed by 3DCRT with an interval of about 4 weeks between. TACE was administered by 5-Fu 500-600 mg m(-2), cis-platinum 30-40 mg m(-2), epi-adriamycin 40-60 mg m(-2) mixed with iodized oil and Gelfoam embolisation. A median of two courses of TACE was given. 3DCRT was delivered by 4-6 coplanar or non-coplanar fields. The mean tumour dose was 43.0+/-6.3 Gy by conventional fractionation (2 Gy per fraction, five fractions a week), and mean dose to normal liver, 19.1+/-6.3 Gy. Acute hepatic toxicities were notable in five patients (10%) with Common Toxicity Criteria (CTC) grade 1 in two cases and grade 3 in three patients, but all recovered eventually. Two patients developed radiation-induced liver disease (RILD) and died soon after the onset of RILD. Four patients had Radiation Therapy Oncology Group (RTOG) grade 1 acute gastrointestinal complication and one patient had acute gastrointestinal bleeding. Five patients experienced RTOG Grade 1 leukopenia and Grade 2 in five cases. Nine patients achieved have partial response, and 37 patients were in stable disease. Four patients were observed to have progressive disease. The overall survival rates at 1 year, 2 years and 3 years were 60%, 38% and 28%, respectively, with a median survival period of 17 months. Irradiation dose, T-stage and hepatic cirrhosis were identified as independent predictors for overall survival by Cox proportional regression analysis. The 1 year, 2 years and 3 years local progression-free rates were 74%, 57% and 38%, and the 1 year, 2 years and 3 years distant metastasis rates were 15%, 21% and 40%, respectively. The combined modality of TACE and 3DCRT was tolerable for the majority of HCC patients, resulted in good outcome and warrants for further prospective trial.