Do Biliary Complications after Hypofractionated Radiation Therapy in Hepatocellular Carcinoma Matter?
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Purpose The purpose of this study is to evaluate the efficacy of hypofractionated radiation therapy (RT) in the treatment of unresectable hepatocellular carcinoma (HCC) after failure of transarterial chemoembolization (TACE) or in cases of refractory HCC, and to investigate biliary complications after hypofractionated RT. Materials and Methods We retrospectively enrolled patients with unresectable, TACE-unresponsive, or refractory HCC treated with hypofractionated RT between July 2006 and December 2012. The perihilar region was defined as the 1-cm area surrounding the right, left, and the common hepatic duct, including the gallbladder and the cystic duct. Significant elevation of total bilirubin was defined as an increase of more than 3.0 mg/dL, and more than two times that of the previous level after completion of RT. Results Fifty patients received hypofractionated RT and 27 (54%) had a tumor located within the perihilar region. The median follow-up period was 24.7 months (range, 4.3 to 95.5 months). None of the patients developed classic radiation disease symptoms, but four patients (8%) showed significant elevation of total bilirubin within 1 year after RT. During follow-up, 12 patients (24%) developed radiologic biliary abnormalities, but only two patients had toxicities requiring intervention. Estimated local progression-free survival, progression-free survival, and overall survival of the patients at 3-year post-hypofractionated RT were 89.7%, 11.2%, and 57.4%, respectively. Conclusion Biliary complications associated with a higher dose exposure of hypofractionated RT were minimal, even in the perihilar region. Hypofractionated RT provided excellent local control and may be a valuable option for treatment of unresectable cases of TACE-unresponsive or refractory HCC.
Abstract
Purpose The purpose of this study is to evaluate the efficacy of hypofractionated radiation therapy (RT) in the treatment of unresectable hepatocellular carcinoma (HCC) after failure of transarterial chemoembolization (TACE) or in cases of refractory HCC, and to investigate biliary complications after hypofractionated RT. Materials and Methods We retrospectively enrolled patients with unresectable, TACE-unresponsive, or refractory HCC treated with hypofractionated RT between July 2006 and December 2012. The perihilar region was defined as the 1-cm area surrounding the right, left, and the common hepatic duct, including the gallbladder and the cystic duct. Significant elevation of total bilirubin was defined as an increase of more than 3.0 mg/dL, and more than two times that of the previous level after completion of RT. Results Fifty patients received hypofractionated RT and 27 (54%) had a tumor located within the perihilar region. The median follow-up period was 24.7 months (range, 4.3 to 95.5 months). None of the patients developed classic radiation disease symptoms, but four patients (8%) showed significant elevation of total bilirubin within 1 year after RT. During follow-up, 12 patients (24%) developed radiologic biliary abnormalities, but only two patients had toxicities requiring intervention. Estimated local progression-free survival, progression-free survival, and overall survival of the patients at 3-year post-hypofractionated RT were 89.7%, 11.2%, and 57.4%, respectively. Conclusion Biliary complications associated with a higher dose exposure of hypofractionated RT were minimal, even in the perihilar region. Hypofractionated RT provided excellent local control and may be a valuable option for treatment of unresectable cases of TACE-unresponsive or refractory HCC.
참고문헌 (25)
- Forner A, "Hepatocellular carcinoma", Lancet, 379, pp.1245~1255 (2012)
- Bruix J, "Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma : subanalyses of a phase III trial", J Hepatol, 57, pp.821~829 (2012)
- Ikeda M, "Efficacy of sorafenib in patients with hepatocellular carcinoma refractory to transcatheter arterial chemoembolization", J Gastroenterol, 49, pp.932~940 (2014)
- 김상원, "Transcatheter arterial chemoembolization and radiation therapy for treatment-naïve patients with locally advanced hepatocellular carcinoma", Radiation oncology journal, 32(1), pp.14~22 (2014), 대한방사선종양학회
- Choi C, "A prospective phase 2 multicenter study for the efficacy of radiation therapy following incomplete transarterial chemoembolization in unresectable hepatocellular carcinoma", Int J Radiat Oncol Biol Phys, 90, pp.1051~1060 (2014)
- Yoon SM, "Stereotactic body radiation therapy as an alternative treatment for small hepatocellular carcinoma", PLoS One, 8, pp.79854~ (2013)
- Jang WI, "High-dose stereotactic body radiotherapy correlates increased local control and overall survival in patients with inoperable hepatocellular carcinoma", Radiat Oncol, 8, pp.250~ (2013)
- Bujold A, "Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma", J Clin Oncol, 31, pp.1631~1639 (2013)
- Kim TH, "Dose-volumetric parameters predicting radiation-induced hepatic toxicity in unresectable hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy", Int J Radiat Oncol Biol Phys, 67, pp.225~231 (2007)
- Cherqui D, "Common bile duct stricture as a late complication of upper abdominal radiotherapy", J Hepatol, 20, pp.693~697 (1994)
- Halevy A, "Radiation stricture of the biliary ducts : an emerging new entity?", HPB Surg, 5, pp.267~270 (1992)
- Bae SH, "Salvage treatment with hypofractionated radiotherapy in patients with recurrent small hepatocellular carcinoma", Int J Radiat Oncol Biol Phys (2012)
- 유정일, "Scheduled Interval Trans-Catheter Arterial Chemoembolization Followed by Radiation Therapy in Patients with Unresectable Hepatocellular Carcinoma", Journal of Korean Medical Science, 27(7), pp.736~743 (2012), 대한의학회[DOI]
- Sapisochin G, "Single HCC in cirrhotic patients : liver resection or liver transplantation? Long-term outcome according to an intention-to-treat basis", Ann Surg Oncol, 20, pp.1194~1202 (2013)
- Klein J, "Hepatocellular carcinoma radiation therapy : review of evidence and future opportunities", Int J Radiat Oncol Biol Phys, 87, pp.22~32 (2013)
- Lee IJ, "Radiotherapeutic strategies in the management of hepatocellular carcinoma", Oncology, 81(Suppl 1:), pp.123~133 (2011)
- 2014 Hepatocellular carcinoma practice guideline, "Korean Liver Cancer Study Group", Korean Liver Cancer Study Group; National Cancer Center, ~ (2014)
- Kim H, "Predictive factors of gastroduodenal toxicity in cirrhotic patients after three-dimensional conformal radiotherapy for hepatocellular carcinoma", Radiother Oncol, 93, pp.302~306 (2009)
- Yoon H, "Predictive factors for gastroduodenal toxicity based on endoscopy following radiotherapy in patients with hepatocellular carcinoma", Strahlenther Onkol, 189, pp.541~546 (2013)
- Beltran MM, "Accuracy of magnetic resonance cholangiography in the evaluation of late biliary complications after orthotopic liver transplantation", Transplant Proc, 37, pp.3924~3925 (2005)
- Giorgio A, "Complications after percutaneous saline-enhanced radiofrequency ablation of liver tumors : 3-year experience with 336patients at a single center", AJR Am J Roentgenol, 184, pp.207~211 (2005)
- Miyayama S, "Main bile duct stricture occurring after transcatheter arterial chemoembolization for hepatocellular carcinoma", Cardiovasc Intervent Radiol, 33, pp.1168~1179 (2010)
- Chiba T, "Proton beam therapy for hepatocellular carcinoma : a retrospective review of 162 patients", Clin Cancer Res, 11, pp.3799~3805 (2005)
- Eriguchi T, "Acceptable toxicity after stereotactic body radiation therapy for liver tumors adjacent to the central biliary system", Int J Radiat Oncol Biol Phys, 85, pp.1006~1011 (2013)
- Song YG, "Transarterial chemoembolization as first-line therapy for hepatocellular carcinomas infeasible for ultrasound-guided radiofrequency ablation: a retrospective cohort study of 116patients", Acta Radiol, 56, pp.70~77 (2015)