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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2018.687    [Accepted]
Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05)
Sun Hyun Bae1, Hee Chul Park2, Won Sup Yoon3, Sang Min Yoon4, In-Hye Jung4, Ik Jae Lee5, Jun Won Kim5, Jinsil Seong6, Tae Hyun Kim7, Taek-Keun Nam8, Youngmin Choi9, Sun Young Lee10, Hong Seok Jang11, Dong Soo Lee12, Jin Hee Kim13
1Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea
2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
3Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea
4Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
5Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
6Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
7Department of Radiation Oncology, Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
8Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea
9Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
10Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Korea
11Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
12Department of Radiation Oncology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
13Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
Correspondence  Won Sup Yoon ,Tel: 82-31-412-6850, Fax: 82-31-412-4214 , Email: irionyws@korea.ac.kr
Sang Min Yoon ,Tel: 82-2-3010-5615, Fax: 82-2-3010-6950 , Email: drsmyoon@amc.seoul.kr
Received: December 11, 2018;  Accepted: April 9, 2019.  Published online: April 10, 2019.
*Sun Hyun Bae and Hee Chul Park contributed equally to this work.
ABSTRACT
Purpose
There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B.
Materials and Methods
We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologicallly effective dose (BED) ≥ 40 Gy10 (α/β = 10 Gy). A total of 184 patients were included in this study.
Results
Initial CP score was seven in 62.0% of patients, eight in 31.0%, and nine in 7.0%. Portal vein tumor thrombosis was present in 66.3% of patients. The BED ranged from 40.4 to 89.6 Gy10 (median, 56.0 Gy10). After RT completion, 48.4% of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9% and 39.8%, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7% experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD.
Conclusion
Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.
Key words: Child-Pugh B, Hepatocellular carcinoma, Hepatic toxicity, Radiotherapy
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