474 Background: Despite retrospective and prospective clinical trials conveying the efficacy of palliative radiation therapy (RT) to the liver, this modality is not commonly used. The purpose of this project is to evaluate trends, dose schemas, and techniques of palliative RT to the liver in current practice. We aim to identify factors associated with overall survival using patient data from the National Cancer Database (NCDB). Methods: Using the NCDB, we analyzed patients with hepatocellular carcinoma (HCC) diagnosed from 2004-2012 treated with palliative RT. Various patient factors were reviewed and survival analyses were performed. Doses were converted to biological effective dose (BED) to compare the different fractionation schemas. Univariate and multivariate analyses were performed with Kaplan Meier and Cox regression tests. Results: A total of 3,267 HCC patients were identified who were treated with palliative intent. Of these 877 (27%) received radiation therapy and only 138 (4% of total, 16% of RT) received radiation therapy to the liver. For those treated with palliative radiation to the liver, the median age was 61 years. Patients with stages I, II, III and IV disease comprised 15%, 15%, 45%, and 25% respectively. Various dose schema and techniques were used. 38% were treated with advanced radiation techniques (24% stereotactic body radiation therapy (SBRT), 14% Intensity-modulated radiation therapy (IMRT). A total of 79 (57%) patients received 10 or fewer fractions, but 32 (40%) of those were SBRT. The median survival was 4.7 months with 16% mortality at 1 month. On multivariate analysis, stage 3 (HR 2.625, p = 0,013) and stage 4 tumors (HR 2.701, p = 0.018), no chemotherapy (HR 1.743, p = 0.025), and lower radiation dose (HR 0.982, p = 0.003) was associated with worse overall survival. Conclusions: Palliative radiation to the liver is not frequently used in patients with HCC. As a result, there is minimal standardization of dose, modality, or treatment schedule. Better understanding of prognostic factors may help better determine the most appropriate plan for each patient to coordinate treatment length with projected survival.
Successful palliative radiation therapy for hemobilia and obstructive jaundice due to bile duct invasion of hepatocellular carcinoma: a case report