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Combination treatment of localized concurrent chemoradiation therapy and transarterial chemoembolization in locally advanced hepatocellular carcinoma with intrahepatic metastasis

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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).

Conflict of interest

None to declare from all authors.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

    Mi Sung Park, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang Hyub Han & Chae Yoon Chon

  2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

    Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang Hyub Han & Chae Yoon Chon

  3. Department of Radiation Oncology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, South Korea

    Jinsil Seong

  4. Liver Cirrhosis Clinical Research Center, Seoul, Korea

    Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang Hyub Han & Chae Yoon Chon

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  1. Mi Sung Park
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Corresponding author

Correspondence to Jinsil Seong.

Additional information

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

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