Abstract
PurposeTo explore the feasibility and safety of centrally located hepatocellular carcinoma (CL-HCC) treated by narrow-margin resection combined with intraoperative electron radiotherapy (IOERT).Methods and MaterialsFrom November 2009 to November 2016, 37 consecutive patients were treated with IOERT as adjuvant treatment during narrow-margin resection for CL-HCC. Long-term outcomes, adverse events for surgery, and acute and chronic toxicities were analyzed.ResultsThe median follow-up was 57.82 months (range, 3.75-111.41 months). A total dose of 15 Gy (range 12 to 17Gy) (prescribed at the 90% isodose) was delivered with a 0.9cm (range 0.8-1.2 cm) median treatment depth targeting the narrow-margin. The 1-year, 3-year and 5-year OS rates were 91.39%, 88.34% and 88.34%, respectively. The 1-year, 3-year and 5-year DFS rates were 80.81%, 68.59% and 54.17%, respectively. In the univariate analysis, none of the treatment characteristics were predictive of overall survival. Fifteen (40.5%) patients suffered from a recurrence event. No patient had marginal recurrence. The 1-year, 3-year and 5-year intrahepatic recurrence rates were 19.75%, 25.92% and 39.58%, respectively. The 1-year, 3-year and 5-year extrahepatic recurrence rates were 2.7%, 5.95% and 9.87%, respectively. There was no 30-day surgical-related death. Three patients had grade 4, and 28 patients had grade 3 alanine aminotransferase (ALT) levels, and seven patients had grade 4, and 30 patients had grade 3 aspartate transaminase (AST) levels. All of them returned to normal within four months. There was no acute radiation-induced liver injury during follow-up. There were no acute or chronic toxicities associated with IOERT.ConclusionIOERT for narrow-margin CL-HCC may achieve good long-term survival outcomes, without significantly increasing acute and chronic toxicities. An IOERT dose of 15Gy may be the safest and most feasible. IOERT might be considered as an adjuvant therapy for CL-HCC patients with a narrow-margin.
Highlights
Hepatocellular carcinoma (HCC) is the third cause of cancerrelated deaths worldwide
The inclusion criteria were: [1] two kinds of imaging examinations or pathologically confirmed Centrally located hepatocellular carcinoma (CL-HCC) prior to surgery; [2] no preoperative radiofrequency, ablation, intervention or chemoradiotherapy; [3] single or multiple lesions limited to three liver segments and able to be completely resected; [4] a resection margin of
From October 2009 to November 2016, the clinical records of 37 consecutive patients diagnosed with CL-HCC treated with Intraoperative electron radiotherapy (IOERT) as adjuvant treatment during narrow-margin resection were retrospectively reviewed in this prospectively assembled database
Summary
Hepatocellular carcinoma (HCC) is the third cause of cancerrelated deaths worldwide. Surgical resection is the main treatment method for HCC patients when liver transplantation is unavailable [2]. Located hepatocellular carcinoma (CL-HCC) is a tumor located at the bifurcation of the portal vein, the confluence of the three main hepatic veins, the inferior vena cava or within 1 centimeter (cm) of the posterior inferior vena cava trunk. It is reported that the recurrence rate of central liver cancer after five years is more than 90%, and the five-year DFS is 15-30% [4, 5]. It is paramount, to find efficacious adjuvant therapies that reduce CL-HCC recurrence
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