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Abstract
Objective: Hypofractionated radiotherapy has recently been applied to treat pulmonary metastases of hepatocellular carcinoma. However, there is no definite evidence on its safety and efficacy. We evaluate the clinical outcomes of hypofractionated radiotherapy for oligo pulmonary metastases of hepatocellular carcinoma in the multicenter and retrospective study.

Methods: From March 2011 to February 2018, 58 patients with fewer than five pulmonary metastases of hepatocellular carcinoma who underwent hypofractionated radiotherapy in nine tertiary university hospitals were analyzed retrospectively. The primary endpoint was the local control rate. The secondary endpoints were overall survival, progression-free survival, prognostic factors affecting the treatment outcomes and treatment-related side effects.

Results: The local tumor response rate including complete and partial response was 77.6% at 3 months after hypofractionated radiotherapy. The median survival and progression-free survival times were 20.9 and 5.3 months, respectively. The 1-year overall survival and progression-free survival rates were 65.5 and 22.4%, respectively. The good treatment response after hypofractionated radiotherapy (P = 0.001), the absence of intrahepatic tumor (P = 0.004) and Child-Pugh class A (P = 0.010) were revealed as significant prognostic factors for overall survival in the multivariate analysis. A progression-free interval of <6 months (P = 0.009) was a negative prognostic factor for overall survival in the multivariate analysis. Of 58 patients, five (8.6%) had grade 2 or higher radiation pneumonitis after hypofractionated radiotherapy.

Conclusions: The favorable local control rate and acceptable toxicity indicate the clinical usefulness of hypofractionated radiotherapy for hepatocellular carcinoma patients who have less than five pulmonary metastases.

Affiliations

In Young Jo  1 , Hee Chul Park  2 , Eun Seog Kim  1 , Seung-Gu Yeo  3 , Myungsoo Kim  4 , Jinsil Seong  5 , Jun Won Kim  5 , Tae Hyun Kim  6 , Won Sup Yoon  7 , Bae Kwon Jeong  8 , Sung Hwan Kim  9 , Jong Hoon Lee  9
1 Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Republic of Korea.
2 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
3 Department of Radiation Oncology, Soonchunhyang University Hospital, Bucheon, Republic of Korea.
4 Department of Radiation Oncology, St. Mary Hospital, Incheon, Republic of Korea.
5 Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
6 Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
7 Department of Radiation Oncology, Korea University College of Medicine, Ansan, Republic of Korea.
8 Department of Radiation Oncology, Gyeongsang National University School of medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
9 Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.