Clinical results and prognostic factors in radiotherapy for unresectable hepatocellular carcinoma: a retrospective study of 158 patients

Abstract

Purpose: To analyze the treatment results and prognostic factors affecting survival in patients with unresectable hepatocellular carcinoma treated with local radiotherapy (RT). Methods and Materials: Between 1992 and 2000, 158 patients with unresectable hepatocellular carcinoma received local RT. Sixty-seven patients had an advanced UICC Stage III lesion and 91 patients had Stage IVA. The mean tumor size was 9.0 ± 3.0 cm, and liver cirrhosis was present in 142 patients. Local RT was combined with transarterial chemoembolization as primary treatment (107 patients) or as salvage after failure of repeated transarterial chemoembolization (51 patients). The mean radiation dose was 48.2 ± 7.9 Gy in daily 1.8-Gy fractions. Results: The mean follow-up was 21.6 months after diagnosis and 14.6 months after RT. The response rate was 67.1%. The overall survival rate at 2 and 5 years was 30.5% and 9%, respectively, from the time of diagnosis (median survival time 16 months) and 19.9% and 4.7%, respectively, after RT (median survival time 10 months). On univariate analysis, tumor size ( p = 0.047), the presence of portal vein thrombosis ( p = 0.007), and RT dose ( p = 0.001) were significant factors for survival. However, on multivariate analysis, RT dose was the only significant factor ( p = 0.01). Conclusion: Local RT achieved substantial tumor regression and survival. The radiation dose was found to be a significant prognostic factor in the RT of hepatocellular carcinoma. Additional efforts for dose escalation are warranted to improve the treatment results in parallel with better protecting the nontumorous liver.