Cancer Res Treat.  2004 Feb;36(1):79-84.

Radioresponse of Hepatocellular Carcinoma-Treatment of Lymph Node Metastasis

• Yoon SM
• Kim JH
• Choi EK
• Ahn SD
• Lee SW
• Yi BY
• Chung YW
• Lee YS
• Seo DJ

Abstract

PURPOSE
To analyze the radioresponse of hepatocellular carcinomas (HCC), using accurate measurements of the tumor size in extrahepatic lymph node metastasis, and to obtain information for the future treatment of primary intrahepatic lesions. MATERIALS AND METHODS: Fifty-one extrahepatic lymph node metastases from primary HCCs, which could be treated by external radiotherapy alone, were included in this study. The radiation dose ranged from 30 to 51 Gy with fraction sizes of 2.0~3.0 Gy. Responses were determined by measuring the areas on CT scans 0, 1 and 3 months after the completion of radiotherapy. The median follow-up period of the surviving patients was 10 months. RESULTS: The overall response rate was 76%, and the important factors were; total dose of radiation, time dose fractionation (TDF) value and the biologically effective dose (BED). A dose of 45 Gy or higher showed an objective response rate of 93%, and if the TDF value was higher than 90, a similar result was observed. In about half (47%) of the patients the maximum response was observed at 3 months or later. The response duration was observable in 14 patients surviving 12 months or longer. Regrowth of irradiated lesions were observed in 4 (66.7%) patients among those who received less than 45 Gy, and in 4 (50%) among those who were treated with 45 Gy or more. There was a statistically significant difference in the survivals between the responders and non-responders (p=0.008). Gastrointestinal bleeding or ulceration was observed in 8 patients, including 3 with NCI common toxicity criteria grade III or higher. CONCLUSION: Radiotherapy was an effective palliative modality for extrahepatic metastasis in HCCs. A radiation dose of 45 Gy or higher (or a TDF value > or =90), was required for a major response.

Keyword

Hepatocellular carcinoma; Radiotherapy

MeSH Terms

Carcinoma, Hepatocellular
Dose Fractionation
Follow-Up Studies
Hemorrhage
Humans
Lymph Nodes*
Neoplasm Metastasis*
Radiotherapy
Tomography, X-Ray Computed
Ulcer

Figure

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  Fig. 1 Overall survival curve for 51 patients. Survival rates at 1, 2 and 3 years were 31.3, 15.7 and 8.7%, respectively, with a median survival time of 7 months.

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  Fig. 2 Survival curves in relation to the radiation response. The two-year survival rate for the 39 patients who achieved either CR or PR after radiation therapy was 20.5%, whereas none of the patients who obtained neither CR nor PR survived for 2 years (p=0.008).

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