Poor Lipiodol Accumulation is an Unfavorable Predictor in Hepatocellular Carcinoma Patients Treated with Transcatheter Arterial Chemoembolization Combined with External Beam Radiation Therapy

Abstract

Transcatheter arterial chemoembolization (TACE) is the first consideration for patients with ≥5 cm in diameter and unresectable hepatocellular carcinoma (HCC), while combined with external beam radiation (EBRT), a better survival is observed due to better local control. But it is lack of the information about relation between the patterns of lipiodol accumulation and the prognosis in those patients treated with EBRT. The purpose of this study is to identify prognostic factors, especially the pattern of lipiodol accumulation in patients treated with TACE combined with EBRT. We retrospectively studied 98 patients with intrahepatic unresectable HCC treated with TACE combined with EBRT, their clinical features, adverse reactions and prognostic factors were analyzed. All patients were treated with TACE 1-11 (median 3) times combined with EBRT 34Gy-66Gy (median 50Gy). The tumor status, laboratory parameters including tumor marker, blood routine and blood biochemistry were followed up. Lipiodol accumulation were assessed on CT scan 4 weeks after the last course of TACE before EBRT and divided them into two types: intense (>3/4 of the tumor volume) or not. All analyses were performed with SPSS. The response rate (CR+PR) after EBRT were 68.2%, 71 patients with positive pretreatment alpha-fetoprotein (AFP), 45 of them had AFP decreased more than 50% after EBRT, the biochemical response rate were 63.3%. The median survival were 23.1 months, overall survival rates were 86.6%, 49.2%, and 28.2% at 1, 2, and 3 years, respectively. Univariate analysis showed that lower serum levels of hemoglobulin and albumin, higher serum levels of bilirubin and alkaline phosphatase, increased AFP after treatment, tumors with diameter over 10cm and poor lipiodol accumulation after TACE were unfavorable prognostic factors. While in multivariate analysis, increased AFP after treatment, tumors with diameter over 10cm and poor lipiodol accumulation after TACE were still significant unfavorable predictors. The tumor burden including larger tumor and poor intrahepatic tumor lipiodol deposit before EBRT are poorer prognostic factors for patients with unresectable intrahepatic HCC, increased AFP level after EBRT is always associated with poorer survival.