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      The retrospective cohort study for survival rate in patients with advanced hepatocellular carcinoma receiving radiotherapy or palliative care

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          Abstract

          Background/Aims

          This study was conducted to investigate the assessment of treatment efficacy of radiotherapy (RT) and other therapeutic modalities compared with palliative care only for treatment with advanced hepatocellular carcinoma (HCC).

          Methods

          From 2002 to 2010, based on the case of 47 patients with advanced HCC, we have investigated each patients' Child-Pugh's class, ECOG performance, serum level of alpha fetoprotein and other baseline characteristics that is considered to be predictive variables and values for prognosis of HCC. Out of overall patients, the 29 patients who had received RT were selected for one group and the 18 patients who had received only palliative care were classified for the other. The analysis in survival between the two groups was done to investigate the efficacy of RT.

          Results

          Under the analysis in survival, the mean survival time of total patients group was revealed between 30.1 months and 45.9 months in RT group, while it was 4.8 months in palliative care group, respectively. In the univariate analysis for overall patients, there were significant factors which affected survival rate like as follows: ECOG performance, Child-Pugh's class, the tumor size, the type of tumor, alpha fetoprotein, transarterial chemoembolization, and RT. The regressive analysis in multivariate Cox for total patients. No treatment under radiotherapy and high level of Child-Pugh's class grade were independent predictors of worse overall survival rate in patients. In contrast, for the subset analysis of the twenty-nine patients treated with radiotherapy, the higher serum level of alpha fetoprotein was an independent predictors of worse overall survival rate in patients.

          Conclusions

          We found that the survival of patients with advanced HCC was better with radiotherapy than with palliative care. Therefore, radiotherapy could be a good option for in patients with advanced HCC.

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          Most cited references30

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          [Practice guidelines for management of hepatocellular carcinoma 2009].

          (2009)
          Hepatocellular carcinoma (HCC) is a major cancer in Korea, typically has a poor prognosis, and constitutes the majority of primary hepatic malignancies. It is the number one cause of death among people in their 50s in Korea. The five-year survival rate of liver cancer is poor; at 18.9%. Efforts to increase the survival rate through early diagnosis of HCC and optimal treatments are keenly needed. Western guideline for the management of HCC were developed, but these guidelines are somewhat unsuitable for Korean patients. Thus, the Korean Liver Cancer Study Group (KLCSG) and the National Cancer Center (NCC), Korea jointly produced the Clinical Practice Guidelines for HCC for the first time in Korea in 2003. Owing to medical advances over the following six years, diagnosis and treatment of HCC has changed considerably. As more national and foreign data are accumulated, KLCSG and NCC, Korea recently revised the Clinical Practice Guidelines for HCC. Forty or more specialists in the field of hepatology, general surgery, radiology and radiation oncology participated, and meticulously reviewed national and foreign papers, and collected opinions through advisory committee conferences. These multidisciplinary, evidence-based guidelines summarized diagnosis, surgical resection, liver transplantation, local treatments, transarterial chemoembolization, radiation therapy, chemotherapy, preemptive antiviral treatments, and response evaluation of HCC. These Korean guidelines are expected to be useful for clinical management of and research on HCC.
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            Partial volume tolerance of the liver to radiation.

            Laura Dawson, Randall Ten Haken (2005)
            The use of conformal radiotherapy (RT) and the follow-up of patients for radiation liver toxicities has led to a quantitative understanding of partial liver RT tolerance. The most common toxicity is radiation-induced liver disease (RILD), a syndrome of anicteric ascites and hepatomegaly. Elevation of transaminases and reactivation of viral hepatitis have also been reported after liver RT. The Lyman normal tissue complication probability (NTCP) model and a local damage-organ injury NTCP model have been used to describe the partial tolerance of the liver to RT. The liver exhibits a large volume effect and a low threshold volume for RILD. The RT tolerance of the liver is reduced in patients with primary liver cancer versus metastases. Elevated transaminases are more common in the presence of poor liver function and hepatitis B infection. If the effective liver volume irradiated is less than 25%, very high RT doses may be delivered with little risk of liver toxicity. The mean liver doses associated with a 5% risk of classic RILD for primary and metastatic liver cancer are 28 Gy and 32 Gy, respectively, in 2 Gy per fraction.
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              Radiation therapy for hepatocellular carcinoma: from palliation to cure.

              Sarah Dawson, A. Hawkins (2006)
              Technologic advances have provided the means to deliver tumoricidal doses of radiation therapy (RT) to patients with unresectable hepatocellular carcinoma (HCC) while avoiding critical normal tissues, providing the opportunity to use RT for curative intent treatment of HCC. For the current report, the expanded role of external beam RT in the setting of HCC from palliation to cure was reviewed. A systematic literature search was undertaken using the MEDLINE data base and secondary references to identify peer-reviewed, English-language articles that reported clinical outcomes after external beam RT alone or in combination with other treatments for HCC. Abstracts from the 2005 American Society of Clinical Oncology, American Society for Therapeutic Radiology and Oncology, American Gastrointestinal Association, and Society of Surgical Oncology Gastrointestinal Cancer Symposium also were included in the search. More than 60 articles reporting on clinical outcomes among patients who received RT for HCC have been published since 1990, including 20 articles that described unique sets of at least 15 patients. RT was used for palliation, to improve local control, and with curative intent in a wide spectrum of patients who most often were unsuitable for surgery and other treatments. Pain reduction following RT was noted in approximately 75% of patients with bone metastases from HCC who received RT. For patients with liver-confined disease treated with conformal RT, proton beam RT, and/or image guided RT with or without transarterial chemoembolization (TACE), local control response rates ranged from 40% to 90%, and the median survival ranges from 10 months to 25 months. For patients with HCC who had portal vein thrombus, the median survival after RT to treat the thrombus and/or the hepatic tumor with or without TACE ranged from 5.3 months to 9.7 months. Although outcomes after high-dose conformal RT for liver-confined HCC were excellent, the potential survival benefit of RT should be tested in randomized controlled trials that require international collaboration. 2006 American Cancer Society
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Hepatol
                Journal ID (publisher-id): KJHEP
                Title: The Korean Journal of Hepatology
                Publisher: The Korean Association for the Study of the Liver
                ISSN (Print): 1738-222X
                ISSN (Electronic): 2093-8047
                Publication date (Print): September 2011
                Publication date (Electronic): 30 September 2011
                Volume: 17
                Issue: 3
                Pages: 189-198
                Affiliations
                Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
                Author notes
                Corresponding author: Byung Seok Lee. Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, 282 Munwha-ro, Jung-gu, Daejeon 301-721, Korea. Tel. +82-42-280-7125, Fax. +82-42-280-7143, gie001@ 123456cnuh.co.kr
                Article
                DOI: 10.3350/kjhep.2011.17.3.189
                PMC ID: 3304653
                PubMed ID: 22102385
                SO-VID: a2e62e15-dea8-4792-bd8d-9accb65494e6
                Copyright © Copyright © 2011 by The Korean Association for the Study of the Liver
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 January 2011
                Date revision received : 18 July 2011
                Date accepted : 18 August 2011
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: alpha-fetoprotein,hepatocellular carcinoma,child-pugh class,survival rate,radiotherapy
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: alpha-fetoprotein, hepatocellular carcinoma, child-pugh class, survival rate, radiotherapy

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