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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.

Author information

Bae SH1, Park HC2, Yoon WS3, Yoon SM4, Jung IH4, Lee IJ5, Kim JW5, Seong J6, Kim TH7, Nam TK8, Choi Y9, Lee SY10, Jang HS11, Lee DS12, Kim JH13.
1
Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea.
2
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
3
Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea.
4
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
5
Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
6
Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
7
Department of Radiation Oncology, Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
8
Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
9
Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea.
10
Department of Radiation Oncology, Chonbuk National University Hospital, Jeonju, Korea.
11
Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
12
Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
13
Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.