Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05)

Sun Hyun Bae, Hee Chul Park, Won Sup Yoon, Sang Min Yoon, In Hye Jung, Ik Jae Lee, Jun Won Kim, Jinsil Seong, Tae Hyun Kim, Taek Keun Nam, Youngmin Choi, Sun Young Lee, Hong Seok Jang, Dong Soo Lee, Jin Hee Kim

Research output: Contribution to journalArticle

Abstract

PURPOSE: There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B. Materials and Methods: We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologically effective dose (BED) ≥ 40 Gy10 (α/β = 10 Gy). A total of 184 patients were included in this study. RESULTS: Initial CP score was seven in 62.0% of patients, eight in 31.0%, and nine in 7.0%. Portal vein tumor thrombosis was present in 66.3% of patients. The BED ranged from 40.4 to 89.6 Gy10 (median, 56.0 Gy10). After RT completion, 48.4% of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9% and 39.8%, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7% experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD. CONCLUSION: Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.

Original languageEnglish
Pages (from-to)1589-1599
Number of pages11
JournalCancer research and treatment : official journal of Korean Cancer Association
Volume51
Issue number4
DOIs
Publication statusPublished - 2019 Oct 1

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Conformal Radiotherapy
Korea
Hepatocellular Carcinoma
Liver Diseases
Radiotherapy
Radiation
Survival
Portal Vein
Disease-Free Survival
Thrombosis
Multivariate Analysis
Survival Rate
Guidelines
Liver

Keywords

  • Child-Pugh B
  • Hepatic toxicity
  • Hepatocellular carcinoma
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05). / Bae, Sun Hyun; Park, Hee Chul; Yoon, Won Sup; Yoon, Sang Min; Jung, In Hye; Lee, Ik Jae; Kim, Jun Won; Seong, Jinsil; Kim, Tae Hyun; Nam, Taek Keun; Choi, Youngmin; Lee, Sun Young; Jang, Hong Seok; Lee, Dong Soo; Kim, Jin Hee.

In: Cancer research and treatment : official journal of Korean Cancer Association, Vol. 51, No. 4, 01.10.2019, p. 1589-1599.

Research output: Contribution to journalArticle

Bae, Sun Hyun ; Park, Hee Chul ; Yoon, Won Sup ; Yoon, Sang Min ; Jung, In Hye ; Lee, Ik Jae ; Kim, Jun Won ; Seong, Jinsil ; Kim, Tae Hyun ; Nam, Taek Keun ; Choi, Youngmin ; Lee, Sun Young ; Jang, Hong Seok ; Lee, Dong Soo ; Kim, Jin Hee. / Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05). In: Cancer research and treatment : official journal of Korean Cancer Association. 2019 ; Vol. 51, No. 4. pp. 1589-1599.
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abstract = "PURPOSE: There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B. Materials and Methods: We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologically effective dose (BED) ≥ 40 Gy10 (α/β = 10 Gy). A total of 184 patients were included in this study. RESULTS: Initial CP score was seven in 62.0{\%} of patients, eight in 31.0{\%}, and nine in 7.0{\%}. Portal vein tumor thrombosis was present in 66.3{\%} of patients. The BED ranged from 40.4 to 89.6 Gy10 (median, 56.0 Gy10). After RT completion, 48.4{\%} of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9{\%} and 39.8{\%}, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7{\%} experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD. CONCLUSION: Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.",
keywords = "Child-Pugh B, Hepatic toxicity, Hepatocellular carcinoma, Radiotherapy",
author = "Bae, {Sun Hyun} and Park, {Hee Chul} and Yoon, {Won Sup} and Yoon, {Sang Min} and Jung, {In Hye} and Lee, {Ik Jae} and Kim, {Jun Won} and Jinsil Seong and Kim, {Tae Hyun} and Nam, {Taek Keun} and Youngmin Choi and Lee, {Sun Young} and Jang, {Hong Seok} and Lee, {Dong Soo} and Kim, {Jin Hee}",
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TY - JOUR

T1 - Treatment Outcome after Fractionated Conformal Radiotherapy for Hepatocellular Carcinoma in Patients with Child-Pugh Classification B in Korea (KROG 16-05)

AU - Bae, Sun Hyun

AU - Park, Hee Chul

AU - Yoon, Won Sup

AU - Yoon, Sang Min

AU - Jung, In Hye

AU - Lee, Ik Jae

AU - Kim, Jun Won

AU - Seong, Jinsil

AU - Kim, Tae Hyun

AU - Nam, Taek Keun

AU - Choi, Youngmin

AU - Lee, Sun Young

AU - Jang, Hong Seok

AU - Lee, Dong Soo

AU - Kim, Jin Hee

PY - 2019/10/1

Y1 - 2019/10/1

N2 - PURPOSE: There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B. Materials and Methods: We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologically effective dose (BED) ≥ 40 Gy10 (α/β = 10 Gy). A total of 184 patients were included in this study. RESULTS: Initial CP score was seven in 62.0% of patients, eight in 31.0%, and nine in 7.0%. Portal vein tumor thrombosis was present in 66.3% of patients. The BED ranged from 40.4 to 89.6 Gy10 (median, 56.0 Gy10). After RT completion, 48.4% of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9% and 39.8%, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7% experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD. CONCLUSION: Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.

AB - PURPOSE: There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B. Materials and Methods: We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologically effective dose (BED) ≥ 40 Gy10 (α/β = 10 Gy). A total of 184 patients were included in this study. RESULTS: Initial CP score was seven in 62.0% of patients, eight in 31.0%, and nine in 7.0%. Portal vein tumor thrombosis was present in 66.3% of patients. The BED ranged from 40.4 to 89.6 Gy10 (median, 56.0 Gy10). After RT completion, 48.4% of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9% and 39.8%, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7% experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD. CONCLUSION: Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.

KW - Child-Pugh B

KW - Hepatic toxicity

KW - Hepatocellular carcinoma

KW - Radiotherapy

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