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Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05)

Cancer Research and Treatment 2019년 51권 4호 p.1589 ~ 1599
 ( Bae Sun-Hyun ) - Soonchunhyang University College of Medicine Department of Radiation Oncology

 ( Park Hee-Chul ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
 ( Yoon Won-Sup ) - Korea University Ansan Hospital Department of Radiation Oncology
 ( Yoon Sang-Min ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
 ( Jung In-Hye ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
 ( Lee Ik-Jae ) - Yonsei University College of Medicine Gangnam Severance Hospital Department of Radiation Oncology
 ( Kim Jun-Won ) - Yonsei University College of Medicine Gangnam Severance Hospital Department of Radiation Oncology
 ( Seong Jin-Sil ) - Yonsei University College of Medicine Severance Hospital Department of Radiation Oncology
 ( Kim Tae-Hyun ) - National Cancer Center Center for Liver Cancer
 ( Nam Taek-Keun ) - Chonnam National University Medical School Department of Radiation Oncology
 ( Choi Young-Min ) - Dong-A University College of Medicine Department of Radiation Oncology
이선영 ( Lee Sun-Young ) - Chonbuk National University Hospital Department of Radiation Oncology
 ( Jang Hong-Seok ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Radiation Oncology
 ( Lee Dong-Soo ) - Catholic University College of Medicine Uijeongbu St. Mary’s Hospital Department of Radiation Oncology
 ( Kim Jin-Hee ) - Keimyung University School of Medicine Dongsan Medical Center Department of Radiation Oncology

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 biologically 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.

키워드

Child-Pugh B; Hepatocellular carcinoma; Hepatic toxicity; Radiotherapy
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