Multimodality Treatment with Radiotherapy for Huge Hepatocellular Carcinoma

Abstract

Background: For huge hepatocellular carcinoma (HCC), therapeutic decisions have varied from local therapy to systemic therapy, with radiotherapy (RT) playing only a palliative role. In this study, we investigated whether multimodality treatment involving RT could be effective in huge HCC. Results: This study was performed in 116 patients with HCC >10 cm. The number of patients in stage II, III and IV was 12, 54 and 50, respectively. RT was given as a combined modality in most patients. The median dose was 45 Gy, with 1.8 Gy per fraction. The median overall survival (OS) and progression-free survival (PFS) were 14.8 and 6.5 months, respectively. The median infield PFS was not reached. Infield failure, outfield intrahepatic and extrahepatic failure were observed in 8.6, 18.1, and 12.1% of patients, respectively. For OS and PFS, number of tumors, initial alpha-fetoprotein (AFP) level, treatment response, percent AFP decrement, and hepatic resection were significant prognostic factors. Tumor characteristics and treatment response were significantly different between long-term survivors and the other patients. Conclusion: Although huge HCC presents an aggressive clinical course, multimodality approaches involving RT can offer an opportunity for prolonged survival.

Concomitant Chemoradiation Using Gemcitabine in Locally Advanced Hepatocellular Carcinoma

“…In patients with huge HCC (>10 cm) treated by multimodality including RT, the significant prognostic factors of survival were number of tumors, initial AFP level, percent AFP decrement, treatment response, and hepatic resection [27].…”

Combined Transarterial Chemoembolization and External Beam Radiotherapy in a Patient with Recurrent Huge Hepatocellular Carcinoma after Hepatic Resection

“…Any single modality, with the exception of hepatic resection, is unable to provide sufficient local tumor control. [10][11][12] Combined locoregional treatments can be effective options because of the expected synergistic effects in selected cases. 13,14 Here, we have presented a case of a patient with recurrent huge HCC who was treated with combined transarterial chemoembolization (TACE) and external beam radiotherapy.…”

“…Therefore, the optimal treatment strategy for unresectable huge HCC has not yet been established. Any single modality, with the exception of hepatic resection, is unable to provide sufficient local tumor control [ 10 - 12 ]. Combined locoregional treatments can be effective options because of the expected synergistic effects in selected cases [ 13 , 14 ].…”