TACE combined with radiotherapy is more effective than TACE alone, and is a promising treatment for unresectable large HCC.

The effects of combined transcatheter arterial chemoembolization (TACE) and radiotherapy in patients with large hepatocellular carcinoma (HCC) were analysed retrospectively. A total of 107 patients with large unresectable HCC was treated with TACE followed by external beam irradiation. The largest dimension of the tumours ranged from 5 cm to 18 cm. Acute effects, survival rates, toxicity and prognostic factors were analysed. Follow-up ranged from 4 months to 98 months (median 24 months). An objective response, i.e. reduction of tumour area greater than 50%, was achieved in 48.6% of cases. In 64.9% of the cases with increased alpha-feto protein (AFP) values, AFP level underwent a reduction of more than 25%. The cumulative survival rates at 1, 3 and 5 years were 59.4%, 28.4% and 15.8%, respectively (median survival 18 months). The combination therapy was generally well tolerated. Only two patients died from liver failure or variceal bleeding associated with therapy. The Cox proportional hazards model showed that the number of tumours and the irradiation dose were independent prognostic factors. The results indicate that combined TACE with radiotherapy is a promising therapeutic approach for large unresectable HCC. Prospective controlled trials to ascertain the real potential benefit of this approach are required.

ObjectivesThe aim of this study was to compare the metastatic patterns of synchronous bone metastasis (SBM) and metachronous bone metastasis (MBM) in nasopharyngeal carcinoma (NPC).MethodsThis study included bone metastases in NPC patients from 2005 to 2016 in a Chinese hospital. Cohort 1 was collected from 2005 to 2010 for discovery, and Cohort 2 from 2011 to 2016 for validation. The chi‐squared test, Wilcoxon rank sum test, and Kaplan–Meier technique were used to compare site, time, and survival between cohorts 1 and 2. Prognostic factors were analyzed using univariate or multivariate Cox regression.ResultsCohort 1 had 112 individuals with SBM and 394 with MBM, and cohort 2 had 328 with SBM and 307 with MBM. The thoracic vertebra was the most frequently affected site of metastasis. Patients with SBM more often had metastasis to the cervical vertebrae compared with patients with MBM (34.5% vs. 22.3%, p < 0.05). Patients with SBM had better overall survival (42.2 months, 95% CI: 33.9–50.7) than patients with MBM (24.9 months, 95% CI: 22.2–28.7). Age at bone metastasis detection, metastasis to other organs, and more bone metastasis locations were associated with worse prognosis. The majority of MBMs occurred at 7 to 18 months after NPC diagnosis.ConclusionRadiotherapy does not modify the metastatic patterns of NPC bone metastases. Patients with SBM tend to have metastasis to the cervical vertebra, which is close to the nasopharynx. Paying more attention to bone metastases during follow‐up in the first 2 years after an NPC diagnosis.