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 (EQD 2 , 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.

No abstract

Introduction: Multiple studies have evaluated the prognostic impact of the time interval (TI) between initial surgery and adjuvant chemotherapy for epithelial ovarian cancer with different time intervals and inconclusive results. The aim of the present study was to evaluate the prognostic impact of a longer interval of 42 days. Methods: In a retrospective single-centre analysis, data were collected for all patients with epithelial ovarian cancer treated between 2007 and 2014. We divided patients by TI: ≤42 days and >42 days. The disease-free survival and overall survival (OS) between the two groups were compared. A Cox regression model was used to evaluate different prognostic factors. A p value <0.05 was considered statistically significant. Results: The median follow-up time was 73 months. Among those with postoperative residual disease (n = 30), TI of >42 days was associated with significantly worse OS (hazard ratio = 3.37, 95% confidence interval = 1.23-9.25, p = 0.02). In cases with residual disease after surgery, the Cox proportional model showed the presence of ascites (p = 0.03) and postoperative CA125 level (p = 0.03) were independent prognostic factors for DFS. TI >42 days (p = 0.03) was an independent negative prognostic factor for OS along with grading (p = 0.05) and presence of ascites (p < 0.01). Conclusion: Our study showed that patients with residual disease after initial surgery had inferior OS when TI was >42 days. Adjuvant chemotherapy in these patients should be started ≤42 days after surgery.

No abstract

No abstract