Abstract
Purpose: A proportion of patients with uninodular hepatocellular carcinoma (HCC) cannot benefit from potential curative therapies such as liver transplantation, surgical resection or radiofrequency ablation. Thus, they are prone to receive transarterial chemoembolization (TACE) that is a palliative option with low probability of both complete response and prolonged local control. Herein, we assessed the combination of TACE and 3D-high dose conformal radiotherapy (3D-HDCRT) for efficacy and safety in HCC. Methods: We retrospectively analyzed the outcome of 35 consecutive patients with uninodular HCC ≤ 100 mm, treated by one course of TACE combined to 3D-HDCRT. The follow-up consisted on clinics, biology, hepatic CT-scan or MRI at month-1 and -3, and thereafter every 3 months. Results: Complete response was obtained in 80% of patients following mRECIST criteria (95% in HCC ≤ 50 mm, and 60% in HCC > 50 mm) with uncommon local recurrence (11%), overall survival rates of 79%, 59% and 44% at respectively 1, 2 and 3 years (median, 37.3 months), and 11.4% grade-3/4 toxicities. Pre-therapeutic α-fetoprotein level ≥ 200 ng/mL was found as a strong predictor of poorer outcome. Conclusion: We showed that TACE combined to 3D-HDCRT can be highly efficient to reach local control and interesting overall survival rates for uninodular HCC, with limited severe toxicities for Child-Pugh A patients. Subsequent prospective controlled trials are warranted for comparison with therapeutic standards.
Highlights
Hepatocellular carcinoma (HCC), one of the most common cancer worldwide, is the main cause of mortality among cirrhotic patients, and ranks third in terms of death by cancer
Except a restrictive population of very early or early stage HCCs that are eligible for curative options such as orthotopic liver transplantation (OLT) or radiofrequency ablation (RFA), the best prognosis remains with surgical resection.[3]
We showed that, for uninodular HCC developed in noncirrhotics or Child-Pugh A cirrhotics, the combination of trans arterial intrahepatic chemoembolization (TACE) and 3D-HDCRT led to high complete response rates, low risk of local recurrence and acceptable toxicity
Summary
Hepatocellular carcinoma (HCC), one of the most common cancer worldwide, is the main cause of mortality among cirrhotic patients, and ranks third in terms of death by cancer. HCC prognosis greatly varies according to tumour size and spread as well as liver functions and general status.[1,2] Except a restrictive population of very early or early stage HCCs that are eligible for curative options such as orthotopic liver transplantation (OLT) or radiofrequency ablation (RFA), the best prognosis remains with surgical resection.[3] This latter can be considered as a curative option, especially for patients with uninodular HCC, and its feasibility is closely linked to the tumour bulk, absence of clinically relevant portal hypertension, and conserved liver functions. Tumour size is not a limiting issue per se, but the best outcome post-surgery remains for patients with HCC ≤ 5 cm. A pattern of concerns arises from uninodular HCCs since they might not be eligible for curative options, and are candidate for trans arterial intrahepatic chemoembolization (TACE)
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