Hypofractionated three‐dimensional conformal radiation therapy for primary liver carcinoma

Abstract

BACKGROUNDThe purpose of the current study was to evaluate the tolerance and efficacy of hypofractionated three‐dimensional conformal radiotherapy (3DCRT) with or without transarterial chemoembolization (TACE) for technically unresectable or medically inoperable primary liver carcinoma (PLC).METHODSBetween April 1999 and August 2003, 128 patients with a clinical diagnosis of PLC received hypofractionated 3DCRT at Cancer Hospital, Guangxi Medical University. Both hypofractionated 3DCRT and TACE were used to treat 48 of these 128 patients. Liver cirrhosis of Child–Pugh Grade A was found in 108 patients, and Grade B was found in 20 patients. The mean gross tumor volume (GTV) was 459 ± 430 cm3. A mean total irradiation dose of 53.6 ± 6.6Gy was delivered at an average fraction of 4.88 ± 0.47Gy, 3 times a week using 8‐MV photons.RESULTSThe median follow‐up time after 3DCRT was 12 months (range, 2–56 mos.). The immediate response rate was 55%. The overall survival rates at 1, 2, and 3 years were 65%, 43%, and 33%, respectively, with a median survival of 20 months (range, 7–31 mos.). Radiation Therapy Oncology Group (RTOG) Grade 2 acute gastrointestinal complications developed in 8 patients, whereas 4 patients developed Grade 3 late gastrointestinal complications. Radiation‐induced liver disease (RILD) developed in 19 (15%) patients, of which 12 had Child–Pugh Grade B liver cirrhosis, and 7 had Grade A. GTV and associated liver cirrhosis were identified by Cox regression analysis as independent predictors for survival (P = 0.044 and 0.015).CONCLUSIONSHypofractionated 3DCRT is effective in carefully selected patients with PLC. Gastrointestinal complications and RILD were the most distinct complications. Cancer 2005. © 2005 American Cancer Society.

Radiation-enhanced hepatocellular carcinoma cell invasion with MMP-9 expression through PI3K/Akt/NF-κB signal transduction pathway

“…These findings are compatible with our clinical observation of more frequent metastasis in HCC patients undergoing fractionated radiotherapy (Cheng et al, 2001;Liang et al, 2005). Given that intrahepatic and extrahepatic metastasis reduces survival in HCC patients, the possibility of metastasis due to radiotherapy deserves serious attention in clinical practice.…”

“…Radiotherapy has been integrated into one of the treatment modalities (Aguayo and Patt, 2001). Several clinical studies showed that a significant proportion of HCC patients undergoing radiotherapy subsequently develop intrahepatic and extrahepatic metastasis (Cheng et al, 2001;Liang et al, 2005). This development was associated with a detrimental outcome.…”

Enhanced cytotoxic effect of low doses of metformin combined with ionizing radiation on hepatoma cells via ATP deprivation and inhibition of DNA repair

“…Cells (1x10 6 ) were seeded in 6-well plates in triplicates. After 24 h, cells were treated with metformin (10 µM) for 1 h followed by IR (2 Gy).…”

“…With developments of imaging techniques, conformal radiotherapy has allowed the delivery of a high dose of radiation to a precise tumor volume while sparing the surrounding normal liver parenchyma. However, survival after radiotherapy remains limited as a result of the high frequency of hepatic recurrences (4)(5)(6). Therefore, it is imperative to discover new therapeutics to improve survival in HCC patients.…”

Investigation of dosimetric variations of liver radiotherapy using deformable registration of planning CT and cone‐beam CT

“…RILD typically occurs 4–8 weeks after RT completion, its clinical characteristics are manifested grossly as nonmalignant ascites, upper gastrointestinal hemorrhage, and veno‐occlusive, which resemble Budd–Chiari syndrome, and RILD is almost fatal since there is no effective treatment at present 4. Liang et al conducted a retrospective study and reported that 19 of 128 (15%) patients were observed developed RILD over 4 weeks after hypo‐fractionated three‐dimensional conformal radiation therapy (3DCRT), while 85% of these RILD patients died from RILD despite receiving appropriate treatments 5. Xu et al reported that 17 of 109 patients developed RILD with elevations of AKP, or sGOT, and sGPT appearing in all patients within 4 months after irradiation, and noted that 13 of 17 (76%) died after onset of RILD 6.…”