Optimal Timing of Radiotherapy after Incomplete Transarterial Chemoembolization for Barcelona Clinic Liver Cancer Stage B Hepatocellular Carcinoma
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Purpose: The optimal timing for radiotherapy (RT) after incomplete transarterial chemoembolization (TACE) remains unclear. This study investigated the optimal timing to initiate RT after incomplete TACE in patients with Barcelona Clinic Liver Cancerstage B hepatocellular carcinoma. Materials and Methods: This study included 116 lesions in 104 patients who were treated with RT after TACE between 2001 and2016. The time interval between the last TACE session and RT initiation was retrospectively analyzed. The optimal cut-off time intervalthat maximized the difference in local failure-free rates (LFFRs) was determined using maximally selected rank statistics. Results: The median time interval was 26 days (range: 2–165 days). At a median follow-up of 18 months (range: 3–160 months),the median overall survival was 18 months. The optimal cut-off time interval appeared to be 5 weeks; using this cut-off, 65 and 39patients were classified into early and late RT groups, respectively. Early RT group had a significantly poorer Child-Pugh class andhigher alpha-fetoprotein levels compared to late RT group. Other characteristics, including tumor size (7 cm vs. 6 cm; p=0.144),were not significantly different between the groups. The 1-year LFFR was significantly higher in the early RT group than in the lateRT group (94.6% vs. 70.8%; p=0.005). On multivariate analysis, early RT was identified as an independent predictor of favorablelocal failure-free survival (hazard ratio: 3.30, 95% confidence interval: 1.50–7.29; p=0.003). Conclusion: The optimal timing for administering RT after incomplete TACE is within 5 weeks. Early administration of RT is associatedwith better local control.
Abstract
Purpose: The optimal timing for radiotherapy (RT) after incomplete transarterial chemoembolization (TACE) remains unclear. This study investigated the optimal timing to initiate RT after incomplete TACE in patients with Barcelona Clinic Liver Cancerstage B hepatocellular carcinoma. Materials and Methods: This study included 116 lesions in 104 patients who were treated with RT after TACE between 2001 and2016. The time interval between the last TACE session and RT initiation was retrospectively analyzed. The optimal cut-off time intervalthat maximized the difference in local failure-free rates (LFFRs) was determined using maximally selected rank statistics. Results: The median time interval was 26 days (range: 2–165 days). At a median follow-up of 18 months (range: 3–160 months),the median overall survival was 18 months. The optimal cut-off time interval appeared to be 5 weeks; using this cut-off, 65 and 39patients were classified into early and late RT groups, respectively. Early RT group had a significantly poorer Child-Pugh class andhigher alpha-fetoprotein levels compared to late RT group. Other characteristics, including tumor size (7 cm vs. 6 cm; p=0.144),were not significantly different between the groups. The 1-year LFFR was significantly higher in the early RT group than in the lateRT group (94.6% vs. 70.8%; p=0.005). On multivariate analysis, early RT was identified as an independent predictor of favorablelocal failure-free survival (hazard ratio: 3.30, 95% confidence interval: 1.50–7.29; p=0.003). Conclusion: The optimal timing for administering RT after incomplete TACE is within 5 weeks. Early administration of RT is associatedwith better local control.
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