Cancer Res Treat.  2017 Jan;49(1):61-69. 10.4143/crt.2016.097.

Clinical Practice Patterns of Radiotherapy in Patients with Hepatocellular Carcinoma: A Korean Radiation Oncology Group Study (KROG 14-07)

Affiliations
  • 1Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. jsseong@yuhs.ac
  • 2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
  • 4Research Institute and Hospital, National Cancer Center, Goyang, Korea.
  • 5Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
  • 6Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 7Department of Radiation Oncology, Korea University Ansan Hospital, Ansan, Korea.
  • 8Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 9Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
  • 10Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 11Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea.
  • 12Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
  • 13Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
  • 14Department of Biostatistics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
The aim of this study was to examine patterns of radiotherapy (RT) in Korean patients with hepatocellular carcinoma (HCC) according to the evolving guideline for HCC established by the Korean Liver Cancer Study Group-National Cancer Center (KLCSG-NCC).
MATERIALS AND METHODS
We reviewed 765 patients with HCC who were treated with RT between January 2011 and December 2012 in 12 institutions.
RESULTS
The median follow-up period was 13.3 months (range, 0.2 to 51.7 months). Compared with previous data between 2004 and 2005, the use of RT as a first treatment has increased (9.0% vs. 40.8%). Increased application of intensity-modulated RT resulted in an increase in radiation dose (fractional dose, 1.8 Gy vs. 2.5 Gy; biologically effective dose, 53.1 Gy10 vs. 56.3 Gy10). Median overall survival was 16.2 months, which is longer than that reported in previous data (12 months). In subgroup analysis, treatments were significantly different according to stage (p < 0.001). Stereotactic body RT was used in patients with early HCC, and most patients with advanced stage were treated with three-dimensional conformal RT.
CONCLUSION
Based on the evolving KLCSG-NCC practice guideline for HCC, clinical practice patterns of RT have changed. Although RT is still used mainly in advanced HCC, the number of patients with good performance status who were treated with RT as a first treatment has increased. This change in practice patterns could result in improvement in overall survival.

Keyword

Hepatocellular carcinoma; Radiotherapy; Clinical practice pattern

MeSH Terms

Carcinoma, Hepatocellular*
Follow-Up Studies
Humans
Liver Neoplasms
Practice Patterns, Physicians'*
Radiation Oncology*
Radiotherapy*

Figure

  • Fig. 1. Overall survival. During the follow-up period, 455 patients died. Median overall survival for all patients was 16.2 months and the 2-year survival rate was 37.7%.

  • Fig. 2. (A) Pattern of failure. Assessment of treatment outcome was available in 734 patients (95.9%). Infield and outfield failure occurred in 235 (32.0%) and 547 (74.5%) patients. (B) Failure-free survival (FFS) for infield failure. Median FFS was not reached and 2-year FFS rate was 58.6%. (C) FFS for outfield failure. Median FFS was 9.8 months and 2-year FFS was 19.9%.

  • Fig. 3. Overall survival according to stage. Overall survival rates at 2 years in each stage were 76.7%, 60.4%, 42.9%, and 22.0%, respectively, and it was significantly different by stage (p < 0.001).


Cited by  3 articles

2018 Korean Liver Cancer Association–National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma
,
Korean J Radiol. 2019;20(7):1042-1113.    doi: 10.3348/kjr.2019.0140.

Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05)
Sun Hyun Bae, Hee Chul Park, Won Sup Yoon, Sang Min Yoon, In-Hye Jung, Ik Jae Lee, Jun Won Kim, Jinsil Seong, Tae Hyun Kim, Taek-Keun Nam, Youngmin Choi, Sun Young Lee, Hong Seok Jang, Dong Soo Lee, Jin Hee Kim
Cancer Res Treat. 2019;51(4):1589-1599.    doi: 10.4143/crt.2018.687.

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

J Liver Cancer. 2023;23(1):1-120.    doi: 10.17998/jlc.2022.11.07.


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