A Comparison of Chemoembolization Combination With and... : The Cancer Journal (original) (raw)

ORIGINAL ARTICLE

A Comparison of Chemoembolization Combination With and Without Radiotherapy for Unresectable Hepatocellular Carcinoma

Zeng, Zhao-Chong MDa; Tang, Zhao-You MDb; Fan, Jia MDb; Zhou, Jian MDb; Qin, Lun-Xiu MDb; Ye, Shen-Long MDb; Sun, Hui-Chuan MDb; Wang, Bin-Liang MDa; Yu, Yao MDb; Wang, Jian-Hua MDc; Guo, Wei PhDd

aDepartment of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China

bLiver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China

cDepartment of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China

dDepartment of Clinical Laboratory, Zhongshan Hospital, Fudan University, Shanghai, China.

Correspondence: Zhao-Chong Zeng, MD, Chairperson, Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China. E-mail: [email protected]

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article. This study was supported by a grant from the Key Center of Hepatoma of Shanghai Municipal Clinical Medicine.

Received on September 29, 2004; accepted for publication September 30, 2004.

Abstract

PURPOSE

This study evaluated the effect of transcatheter arterial Chemoembolization combined with external beam radiotherapy on the response rates and survival of patients with unresectable hepato-cellular carcinoma. Transcatheter arterial Chemoembolization is frequently used for the treatment of this cancer, but complete or massive necrosis is seldom observed. Historically, radiotherapy for hepatocellular carcinoma has yielded poor long-term survival. Multimodality therapy has been initiated in an effort to improve survival statistics.

PATIENTS AND METHODS

We retrospectively studied 203 patients with unresectable hepatocellular carcinoma, who were free of tumor thrombus, lymph node involvement, or extrahepatic metastasis based on computed tomography scans of the chest and abdomen. Among the 203 patients who received transcatheter arterial Chemoembolization as initial therapy, 54 also received combination therapy with external beam radiotherapy. Tumor response rate, survival, and failure patterns were analyzed and compared between the two groups.

RESULTS

Objective responses (complete and partial responses) on computed tomography study were observed in 31% and 76% of patients in the non-radiotherapy and radiotherapy groups, respectively. Overall survival rates in the patients in the radiotherapy group were 71.5%, 42.3%, and 24.0% at 1, 2, and 3 years, respectively, improved over the non-radiotherapy group rates of 59.6%, 26.5%, and 11.1% at 1, 2, and 3 years, respectively. Intrahepatic failure was lower in the radiotherapy group than in the non-radiotherapy group, but the difference was not significant. Side effects from radiotherapy were common, but rarely severe.

CONCLUSIONS

This retrospective study suggests that the outcome of unresectable hepatocellular carcinoma can be influenced by radiation therapy, but a prospective randomized trial would be necessary to draw definitive conclusions.