Palliative Liver Radiotherapy (RT) for Symptomatic Hepatocellular Carcinoma (HCC)

Cynthia S Y Yeung,Francis A S Lee,Natalie S M Wong,Mark K H Chan,K S Tsang,B Wang,Venus W Y Lee,C L Chiang,S K Ha,Connie H M Ho

doi:10.1038/s41598-020-58108-1

Abstract

This study aims at evaluating the symptom response, response duration, and toxicity of single dose palliative liver radiotherapy (RT) for symptomatic HCC patients. We reviewed unresectable HCC patients treated with palliative RT in our institution. Eligible patients were unsuitable or refractory to trans-arterial chemoembolization (TACE) and stereotactic body radiotherapy (SBRT), with an index symptom of pain or abdominal discomfort. The primary outcome was the percentage of patients with clinical improvement of index symptom at 1 month. Secondary outcomes were response duration, toxicities, alpha-feto protein (AFP) response, and radiological response. Fifty-two patients were included in the study. The index symptom was pain in 34 patients (65.4%), and abdominal discomfort (34.6%) in 18 patients. At 1 month, 51.9% of patients had improvement of symptoms. Median time to symptom progression was 89 days (range: 12–392 days). Treatment was well tolerated with only 2 patients (3.8%) developing grade 3 GI toxicities. AFP response, radiological response rate, and disease control rate at 3 months were 48.6%, 15.1%, and 54.5% respectively. Half of the patients had improvement of index symptoms after receiving palliative liver RT with median response duration of 3 months. The treatment was well tolerated with minimal toxicities.

Highlights

Hepatocellular carcinoma (HCC) is the leading cause of global cancer death[1]
From July 2012 to December 2017, a total of 52 patients fell under the aforementioned eligible criteria were treated and prospectively followed in accordance to our institutional protocol
This study supports the findings of previous phase II trial that palliative RT 8 Gy single fraction is an effective regime in relieving hepatic pain or abdominal discomfort in advanced HCC patients[15]

Summary

Introduction

Hepatocellular carcinoma (HCC) is the leading cause of global cancer death[1]. Surgical interventions provide the only chance of cure, yet majority of patients present with advanced disease and are treated with trans-arterial chemoembolization (TACE), targeted therapy, or best supportive care (BSC). Patients who present in advanced stage often experience symptoms of pain or abdominal discomfort at some point of their illnesses[6]. In the early studies of whole-liver RT in patients mainly with liver metastases at doses ranging from 20–30 Gy, benefit of symptom palliation was observed in 49–95% of patients with limited toxicities[7,8,9,10,11,12,13,14]. Palliative liver RT is indicated in Barcelona Clinic Liver Cancer (BCLC) advanced or terminal stage (BCLC stage C and D) patients with tumor causing hepatic pain or abdominal discomfort. This study aims at evaluating the symptom response, response duration, and toxicity of palliative liver RT in symptomatic HCC patients

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Conclusion