Purpose: External beam radiotherapy (EBRT) has been commonly applied as salvage or a combination locoregional modality after transarterial chemoembolization (TACE) for hepatocellular carcinomas (HCCs). This study reports oncologic outcomes and feasibility after application of the two modalities in our center.
Methods: Forty consecutive patients who underwent EBRT due to incomplete responses of TACE were evaluated. Fourteen patients (35.0%) received stereotactic body radiotherapy (SBRT) and the remaining patients received conventionally fractionated radiotherapy (RT). A majority of patients who underwent SBRT received doses of 27 to 48 Gy in 3~4 fractions (median *EQD2: 57.0 Gy). Conventionally fractionated RT was performed with a median EQD2 of 47.8 Gy.
Results: The median follow up duration was 14.4 months (range: 2.6~83.0 months). A majority (77.5%) of patients were regarded as having Child Pugh grade A. The median tumor size was 3.4 cm (range: 0.8~20.1 cm). Ten patients (25.0%) had thrombosis at a main portal branch. The 1~ and 2~year overall survival (OS) and progression free survival (PFS) rates were 82.2% and 42.1% and 55.8% and 32.1%, respectively. The local control rates were 89.1% and 89.1% at 1 and 2 years, respectively. The albumin level was a significant factor affecting OS (p = 0.002), and the BCLC stage significantly affected PFS (p = 0.001). Intrahepatic, out of field recurrence was the main cause of disease progression (60.0%), and distant metastasis developed in 12 patients (30.0%) during follow up. Non classic radiation induced liver disease was seen in five (12.5%) patients, and two (5%) patients experienced grade ≥3 hepatic toxicities.
Conclusions:
EBRT after incomplete TACE was feasible and yielded favorable oncologic outcomes. However, disease progression related to intrahepatic failure remained a hindrance.
1007P cfDNA and ctDNA variations are predictive of disease progression to conventional transarterial chemoembolization (cTACE) in patients with hepatocellular carcinoma (HCC)
