The Role of Locoregional RT in Barcelona Clinic Liver Cancer Stage C Hepatocellular Carcinoma Patients Treated With Sorafenib

Abstract

This study aimed to investigate the clinical benefits of locoregional radiation therapy (RT) before, after, and concurrent with sorafenib therapy for Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) patients.Patients treated with sorafenib for BCLC stage C HCC between January 2015 and December 2017 at two institutions were retrospectively reviewed. Patients received RT for either curative or palliative aims. In this study, only RT to locoregional sites including primary HCC, portal vein tumor thrombosis, or regional lymph node metastasis were analyzed.Among 398 patients treated with sorafenib, 68 (17.1%) patients were treated with locoregional RT for BCLC stage C HCC. At a median follow-up of 9.5 months, median progression-free survival (PFS) and overall survival (OS) were 2.2 and 9.5 months, respectively. In the multivariate analysis, locoregional RT (HR 0.57; 95% CI, 0.42-0.79, P < 0.001) was associated with favorable OS. After 1:1 propensity score matching, patients who did not receive locoregional RT showed worse OS than those who received RT (median 9.6 months vs 15.7 months, P = 0.017). Upfront sorafenib and upfront locoregional RT did not show statistically significant difference in OS, whereas RT dose ≥ 50 GyEQD2 resulted in prolonged OS compared with RT dose < 50 GyEQD2.Locoregional RT was significantly associated with longer survival in BCLC stage C HCC patients treated with sorafenib. Therefore, incorporating locoregional RT to these patients even after sorafenib failure could be considered to improve dismal prognosis of BCLC stage C HCC patients.