Abstract
Purpose
Although sorafenib has been approved for treating advanced hepatocellular carcinoma (HCC), its high cost, frequent adverse events, and unsatisfactory efficacy remain unresolved. We evaluated the efficacy and safety of the combination treatment of localized concurrent chemoradiation therapy (CCRT) for locally advanced HCC with portal vein thrombosis (PVT) and transarterial chemoembolization (TACE) for intrahepatic metastasis.
Methods
Between January 2006 and June 2011, 30 patients with HCC with portal vein invasion and intrahepatic metastasis were enrolled. After TACE for intrahepatic metastasis, localized CCRT (45 Gy over 5 weeks with conventional fractionation and hepatic artery infusional chemotherapy using 5-fluorouracil as a radiosensitizer, administered during the first and fifth weeks of radiotherapy) was used to treat main HCC with PVT. The modified response evaluation criteria in solid tumors (mRECIST) were used to evaluate tumor response.
Results
The median age of the patients (26 men, 4 women) was 51 years. Objective response rates were 30.0 % (9/30) and 32.1 % (9/28) in the intention-to-treat and per protocol analyses, respectively. The median progression-free survival (PFS) and overall survival (OS) were 4.5 and 9.8 months, respectively. Baseline α-fetoprotein (AFP) correlated significantly with PFS (P = 0.008), whereas baseline AFP, completion of the protocol, and overall radiological response influenced OS significantly (all P < 0.05). All adverse events were predictable and manageable with conservative care.
Conclusions
Combination treatment of localized CCRT and TACE was effective and tolerable in patients with locally advanced HCC with PVT and intrahepatic metastasis. This protocol may be an alternative option when sorafenib cannot be prescribed.
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Acknowledgments
This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A102065) and by a grant from the National R&D Program for Cancer Control, Ministry for Health and Welfare, Republic of Korea (0620390).
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M. S. Park and S. U. Kim are co-first authors of this article, and have contributed equally.
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280_2012_1993_MOESM1_ESM.jpg
Supplementary figure 1. CT findings of PR (A), SD (B), and PD (C) after localized CCRT and TACE (arterial phase). A: After treatment, the diameter of main HCC with PVT showing arterial enhancement significantly decreased (PR) and intrahepatic metastatic HCCs showed compact lipiodolization (CR, white arrow). A hemangioma was noted at segment 4. B: Although intrahepatic metastatic lesion showed compact lipiodolization after treatment (CR, white arrow), the diameter of main HCC with PVT showing arterial enhancement did not decreased (from 7.5 to 7.2 cm; 4.0% decrease; SD) enough to meet the criteria of PR. Thus, overall response was SD. C: After treatment, the diameter of main HCC with PVT showing arterial enhancement increased (from 11.8 to 14.5 cm; 22.4% increase; PD) although intrahepatic metastatic lesion showed compact lipiodolization (CR, white arrow). Thus, overall response was PD. (JPEG 131 kb)
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Park, M.S., Kim, S.U., Park, J.Y. et al. Combination treatment of localized concurrent chemoradiation therapy and transarterial chemoembolization in locally advanced hepatocellular carcinoma with intrahepatic metastasis. Cancer Chemother Pharmacol 71, 165–173 (2013). https://doi.org/10.1007/s00280-012-1993-9
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DOI: https://doi.org/10.1007/s00280-012-1993-9