Gastrointestinal Cancer

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SU_12_2122 - High-Dose Radiation in Liver-Directed Concurrent Chemoradiotherapy Is Effective for Locally Advanced BCLC Stage C Hepatocellular Carcinoma

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

High-Dose Radiation in Liver-Directed Concurrent Chemoradiotherapy Is Effective for Locally Advanced BCLC Stage C Hepatocellular Carcinoma
H. K. Byun, H. J. Kim, and J. Seong; Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South)

Purpose/Objective(s): Recent advances in radiotherapy (RT) technologies, such as intensity-modulated radiotherapy (IMRT), have enabled the delivery of tumoricidal doses to intrahepatic malignancies while protecting the normal organs. This study evaluated the effects of high-dose RT among patients with locally advanced Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma (BCLC-C HCC).

Materials/Methods: This study retrospectively evaluated data from 637 patients who received RT with concurrent hepatic arterial floxuridine for BCLC-C HCC without distant metastases during 2005–2016. These cases included 514 patients (81%) who were treatment-naïve. Receiver operating characteristic curve analysis showed that the optimal cut-off for the biologically effective dose (BED) was 72 Gy, and the patients were divided into ≥72 Gy (n=101) and BED <72 Gy (n=536). In the BED ≥72 Gy and <72 Gy groups, 94 of 101 patients (93%) and 128 of 536 patients (24%) used IMRT, respectively.

Results: The median overall survival (OS) was 16.3 months, with a median follow-up of 12.4 months (19.8 months among patients who were alive). The BED ≥72 Gy and <72 Gy groups had median OSs of 39.7 months and 14.5 months, and 1-year OS rates of 73% and 58%, respectively (P<.001). The 1-year local control (LC) rate was significantly higher in the high-dose group (95% vs. 78%; P<.001). After propensity score matching, 83 matched pairs were created, and the high-dose group still had significantly better 1-year LC rate (95% vs. 82%; P=.006) and 1-year OS rate (71% vs. 62%; P=.01). In the multivariate model, the BED ≥72 Gy was an independent predictor of LC (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.11–0.61; P=.002) and OS (HR 0.50; 95% CI, 0.33–0.77, P=.002). The surgical conversion rate was significantly higher in the high-dose group (20% vs. 12%, P=.03), with markedly increased median OS among patients who underwent surgery (103.8 months vs. 13.1 months; P<.001). There were no significant differences in gastrointestinal bleeding or radiation-induced liver disease.

Conclusion: High-dose RT which was enabled by IMRT increased LC and OS after liver-directed chemoradiotherapy for locally advanced BCLC-C HCC. It also increased the surgical conversion rate, which contributed to the improved OS.

Author Disclosure: H. Byun: None. H. Kim: None. J. Seong: None.

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