The Efficacy of High-dose 3-Dimensional Conformal Radiation Therapy in Patients With Small Hepatocellular Carcinoma Not Eligible for Other Local Modalities

Abstract

Purpose: To analyze the efficacy and toxicity of high-dose 3-dimensional conformal radiation therapy (3D-CRT) for patients with small hepatocellular carcinoma (HCC) not eligible for other local modalities. Methods: Between 1998 and 2006, 61 patients with small HCC were treated with high-dose 3D-CRT. The eligibility criteria were as follows: (1) HCC <5 cm; (2) HCC without vascular invasion; (3) HCC without extrahepatic metastasis; and (4) not eligible for other local modalities. The median RT dose was 54 Gy (range, 36 to 55 Gy) daily in 2.5 to 5Gy fractions. We evaluated tumor response, local control, overall survival, pattern of failure, and toxicity. Results: The median follow-up period was 16.7 months. Tumor response was 68.9% (42 of 61 lesions) with a complete response in 27 lesions (44.3%). Local control was 93.8% at 1 year and 86.9% at 3 years. Intrahepatic metastases developed in 40 patients (65.6%). Thirteen patients (22.3%) had extrahepatic metastasis. The median survival was 56 months (range, 2.8 to 68.1 mo), and the overall survival rate was 81.1% at 1 year and 58.4% at 3 years. Three patients developed radiation-induced liver disease, but there were no instances of grade 3 or higher toxicity. Conclusions: High-dose 3D-CRT for small HCC <5 cm showed favorable local control and overall survival without serious complications. RT might be an effective local modality in patients with small HCC not eligible for other local modalities.