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01-02-2020 | Hepatocellular Carcinoma | Original Article

Dose escalation in radiotherapy for incomplete transarterial chemoembolization of hepatocellular carcinoma

Authors: Hwa Kyung Byun, MD, Hyun Ju Kim, MD, Yoo Ri Im, Do Young Kim, MD, PhD, Kwang-Hyub Han, MD, Jinsil Seong, MD, PhD

Published in: Strahlentherapie und Onkologie | Issue 2/2020

Abstract

Purpose

To investigate the efficacy of radiation dose escalation in patients with hepatocellular carcinoma (HCC) after incomplete transarterial chemoembolization (TACE).

Methods

This study evaluated retrospective data of 323 HCC patients who received radiotherapy after incomplete TACE from 2001–2016. Radiation dose in biologically effective dose (BED) (α/β = 10) was categorized as <72 Gy (261 patients) and ≥72 Gy (62 patients). Simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) was used significantly more frequently in the high-dose group (64.5% vs. 12.9%; P < 0.001). Local failure-free rate (LFFR), progression-free rate (PFR), and toxicities were compared between the two groups. Additionally, propensity score matching was performed.

Results

Median follow-up time for patients who were alive at the time of analysis was 47 months (range 18–189 months). Median overall survival after radiotherapy was 14 months. In multivariate analysis, BED ≥72 Gy was an independent predictor of favorable LFFR (hazard ratio [HR] 0.32; 95% confidence interval [CI] 0.14–0.72; P = 0.006) and PFR (HR 0.67; 95% CI 0.45–0.98; P = 0.04). In the propensity score-matched cohort (62 pairs), 1‑year LFFR (94% vs. 81%; P = 0.002), and 1‑year PFR (49% vs. 42%; P = 0.01) were significantly higher in the high-dose group. Treatment-related toxicities were comparable between the high-dose and low-dose groups (classic radiation-induced liver disease: 5.3% [3/57] vs. 13.8% [29/210], P = 0.08; grade 2–4 gastrointestinal bleeding: 3.2% [2/62] vs. 7.3% [19/261], P = 0.39).

Conclusion

Radiation dose with BED ≥72 Gy improved LFFR and PFR without increasing toxicity. In radiotherapy for incomplete TACE of HCC, dose escalation using SIB-IMRT should be actively considered to improve oncologic outcome.

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Title: Dose escalation in radiotherapy for incomplete transarterial chemoembolization of hepatocellular carcinoma
Authors: Hwa Kyung Byun, MD
Hyun Ju Kim, MD
Yoo Ri Im
Do Young Kim, MD, PhD
Kwang-Hyub Han, MD
Jinsil Seong, MD, PhD
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Hepatocellular Carcinoma
Radiotherapy
Hepatocellular Carcinoma
Published in: Strahlentherapie und Onkologie / Issue 2/2020
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-019-01488-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dose escalation in radiotherapy for incomplete transarterial chemoembolization of hepatocellular carcinoma

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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