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Abstract
Purpose: External beam radiotherapy (EBRT) has been commonly applied as salvage or a combination locoregional modality after transarterial chemoembolization (TACE) for hepatocellular carcinomas (HCCs). This study reports oncologic outcomes and feasibility after application of the two modalities in our center.

Methods: Forty consecutive patients who underwent EBRT due to incomplete responses of TACE were evaluated. Fourteen patients (35.0%) received stereotactic body radiotherapy (SBRT) and the remaining patients received conventionally fractionated radiotherapy (RT). A majority of patients who underwent SBRT received doses of 27 to 48 Gy in 3-4 fractions [median EQD2 (Equivalent dose in 2 Gy per fraction radiotherapy): 57.0 Gy]. Conventionally fractionated RT was performed with a median EQD2 of 47.8 Gy.

Results: The median follow-up duration was 14.4 months (range: 2.6-83.0 months). A majority (77.5%) of patients were regarded as having Child-Pugh grade A. The median tumor size was 3.4 cm (range: 0.8-20.1 cm). Ten patients (25.0%) had thrombosis at a main portal branch. The 1- and 2-year overall survival (OS) and progression-free survival (PFS) rates were 82.2% and 42.1% and 55.8% and 32.1%, respectively. The local control rates were 89.1% and 89.1% at 1 and 2 years, respectively. The albumin level was a significant factor affecting OS (p = .002), and the BCLC stage significantly affected PFS (p = .001). Intrahepatic, out-of-field recurrence was the main cause of disease progression (60.0%), and distant metastasis developed in 12 patients (30.0%) during follow-up. Non-classic radiation-induced liver disease was seen in five (12.5%) patients, and two (5%) patients experienced grade ≥3 hepatic toxicities.

Conclusions: EBRT after incomplete TACE was feasible and yielded favorable oncologic outcomes. However, disease progression related to intrahepatic failure remained a hindrance.

 incomplete TACE (A) tumor; (B) 방사선치료 후 hypoxic, avascular core에 TACE가 반응한 사례

혈관접근이 불량한 segment 4의 tumor (A, B) 에 방사선치료 후 종양이 관해 (C) 된 사례

Affiliation

Sunmin Park  1 , Won Sup Yoon  1 , Mi Hee Jang  1 , Chai Hong Rim  1
1 Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Gyeong-Gi Do, Republic of Korea.