Identifying the optimal criteria of radiotherapeutic parameters for patients with unresectable locally advanced hepatocellular carcinoma.

Seok Hyun Son,Hong Seok Jang,Chul Seung Kay,Soo Yoon Sung,Sojung Lee,Hye Jin Kang

doi:10.18632/oncotarget.5713

Seok Hyun Son, Hong Seok Jang + Show 4 more

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https://doi.org/10.18632/oncotarget.5713

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Abstract

The purpose of this study is to identify the optimal criteria of the radiotherapeutic parameters in patients with unresectable locally advanced hepatocellular carcinoma (HCC). 103 patients were enrolled in this study. All patients received RT delivered using the TomoTherapy Hi-Art system between March 2006 and February 2012. We evaluated the planning target volume (PTV), total dose (Gy10), and NTNL-V(BED20) (non-target normal liver volume receiving more than a biologically effective dose of 20 Gy8) as significant radiotherapeutic parameters associated with hepatic function deterioration and local progression-free survival (PFS). A PTV of 279 cm3 or 304 cm3, a total dose of 60 Gy10, and a NTNL-V(BED20) of 40.8% were identified as the optimal cut-off values of radiotherapeutic parameters to prevent hepatic function deterioration and prolong local PFS. Based on these findings, patients were divided in a favorable and an unfavorable prognosis group. The differences in median local PFS, overall survival, and incidence of deteriorated hepatic function between the two groups were 11.2 months, 11.1 months, and 71.7%, respectively (p < 0.001 in each case). In conclusion, we suggest that the optimal criteria of the radiotherapeutic parameters for patients with unresectable locally advanced HCC are: PTV ≤ 279 cm3, total dose > 60 Gy10, and NTNL-V(BED20) ≤ 40.8%.

Highlights

The standard treatments for unresectable hepatocellular carcinoma (HCC) are transarterial chemoembolization (TACE) and sorafenib
Because the improved gain of survival cannot be achieved in all patients received RT, it is important to establish the optimal criteria of radiotherapeutic parameters in order to improve its efficacy
We attempted to identify the optimal cut-off values of radiotherapeutic parameters associated with local progression-free survival (PFS) and hepatic function deterioration to enhance its safety and efficacy

Summary

Introduction

The standard treatments for unresectable hepatocellular carcinoma (HCC) are transarterial chemoembolization (TACE) and sorafenib. TACE is currently recommended for large multinodular HCC, while sorafenib is the suggested first-line of treatment for HCC with vascular invasion or extrahepatic spread. There is strong evidence that TACE enhances the survival of patients with unresectable locally advanced HCC [1, 2]. Radiotherapy (RT) in addition to TACE could overcome these limitations and improve clinical outcomes [4,5,6,7,8,9]. Many studies have suggested RT as an effective treatment option for patients with unresectable locally advanced HCC [12, 13]. A new strategy including RT is needed in the treatment of unresectable locally advanced HCC

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