Prognostic Factors and Survival in Advanced Large Hepatocellular Carcinomas Treated with Combined Transarterial Chemoembolisation and Hypofractionated Image-guided Radiotherapy

• Published in: Hong Kong journal of radiology : HKJR = Xianggang fang she ke yi xue za zhi Vol. 23; no. 3; pp. 198 - 207
• Main Authors: Wong, NSM, Chiang, CL, Ho, CHM, Yip, WWL, Yeung, CSY, Chan, MKH, Lee, VWY, Lee, FAS, Wong, FCS
• Format: Journal Article
• Language: English
• Published: Hong Kong Hong Kong Academy of Medicine 01-09-2020
• Subjects: Ablation; Ascites; Cancer therapies; Disease; Hepatitis; Liver cancer; Medical prognosis; Patients; Radiation therapy; Survival analysis; Tumors; Hong Kong; United States > US
• ISSN: 2223-6619; 2307-4620
• DOI: 10.12809/hkjr2017152

Objectives Large (≥10 cm) hepatocellular carcinomas (HCCs) carry a dismal prognosis and respond poorly to transarterial chemoembolisation (TACE). Combined TACE and hypofractionated image-guided radiotherapy (HIGRT) has emerged as a new treatment strategy. We evaluated its efficacy among these tumours and report the predictors of overall survival (OS). Methods Data from 55 consecutive cases treated with preplanned combined TACE and HIGRT from 2007 to 2017 were evaluated from a prospectively collected database. Patients with advanced HCCs ≥10 cm, ineligible for curative intervention and with Child-Pugh scores ≤B7, received one dose of preplanned TACE 4 weeks prior to HIGRT. HIGRT doses were individualised according to the dose constraints of uninvolved liver and neighbouring organs at risk. OS was the primary endpoint. Results In all, 55 patients with median tumour sizes of 15.3 cm were included. Tumour vascular thromboses and extrahepatic diseases were present in 25.5% and 32.7%, respectively. The median total equivalent dose in 2 Gy/fr (EQD2, α/β ratio = 10) was 32.7 Gy. The 2-year OS reached 24.9%. Clinical benefit rate was 83.6% with a 1-year local control rate of 57.4%. Multivariate analyses revealed alpha-fetoprotein (AFP) level (hazard ratio = 2.2, p = 0.025) and subsequent local treatment (hazard ratio = 0.2, p = 0.001) to be independent OS predictors. Responders undergoing subsequent curative resection achieved significantly better median OS than those without. Conclusion Combined TACE and HIGRT achieved favourable survival outcomes among large HCCs. AFP level and subsequent local surgery were independent negative and positive OS predictors, respectively. Future studies are warranted.