Effectiveness and feasibility of external beam radiotherapy for hepatocellular carcinoma with inferior vena cava and/or right atrium involvement: a multicenter trial in Korea (KROG 17-10)

Abstract

Purpose: Hepatocellular carcinoma (HCC) involving the inferior vena cava (IVC) and/or right atrium (RA) can affect systemic circulation, causing fatal complications. Standard treatment is yet to be established due to its rarity and intractability. We sought to determine the clinical efficacy of external beam radiotherapy (EBRT) in HCC treatment.

Patients and methods: Our group designed this multicenter trial and recruited patients with HCC and IVC and/or RA involvement. Forty-nine patients from six institutions received EBRT with median dose of 46.7 (range: 35.4–71.5) Gy during 2009–2016. The primary outcome was overall survival (OS), and relevant predictors were evaluated.

Results: Median follow-up length was 9.3 (range: 1.1–119) months. Median survival, 1-, and 2- year OS rates were 10.1 months (95% confidence interval [CI]: 7.5–12.7 months), 43.5%, and 30.1%, respectively. Significant factors affecting OS were alpha-fetoprotein level ≥300 ng/mL (risk ratio [RR]: 2.34, p = .025), tumor multiplicity (RR: 2.56, p = .028), and patient volume of institutions (high- vs. middle volume centers) (RR: 3.58, p = .001). Local control rates were 88.7% and 74.5% at 1 and 2 years, respectively. The most common first failure site was the lung (21/49, 42.9%) followed by liver outside the EBRT field (17/49, 34.7%). One case of possible radiation-induced liver disease was noted, with transient alkaline phosphatase elevation.

Conclusion: EBRT can yield favorable local control in HCC with IVC and/or RA involvement. Systemic treatment may be more indicated as factors reflecting tumor aggressiveness were significant, and first distant failure is common.

Keywords:

• Liver neoplasm
• inferior vena cava
• right atrium
• radiotherapy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the National Research Fund of Korea [NRF-2018R1D1A1B07046998].

Notes on contributors

Chai Hong Rim

Chai Hong Rim is a radiation oncologist and a passionate researcher, who published more than 25 articles as a primary or corresponding author in recent 3 years, including 11 articles about radiotherapy for hepatocellular carcinoma. He has also academic expertise in treating lung cancer, meta-analysis, and prevention oncology.

Bae-Kwon Jeong

Bae-Kwon Jeong is an experienced radiation oncologist who has strong expertise in radiosurgery using cyberknife. He has participated in more than 50 academic articles of radiation oncology.

Tae Hyun Kim

Tae-Hyun Kim is a radiation oncologist specialized in treating hepatocellular carcinoma. He has been a director of proton therapy center in National Cancer Center of Korea. He served as an author for more than 40 articles regarding radiotherapy for hepatocellular carcinoma.

Jin Hee Kim

Jin Hee Kim is an experienced radiation oncologist, who has served as a director of radiation oncology division in Keimyung University. She served as an author for more than 150 academic articles of radiation oncology.

Hyun-Cheol Kang

Hyun-Cheol Kang is a radiation oncologist specialized in treating gastrointestinal cancer. He participated as an author for more than 20 academic articles of radiation oncology.

Jinsil Seong

Jinsil Seong is a professor in Radiation Oncology at Yonsei University Medical College, Korea. She is also President of the Asia Pacific Primary Liver Cancer Expert (APPLE) Association and Executive Board member for the Asian Oncologic Society. She has received many awards involving Adrienne Wilson Liver Cancer Association’s Blue Faery Award for Excellence in Liver Cancer Research, the Cancer Prevention Award from the Korean Ministry of Health and Welfare, and the Distinguished Scientific Award from the Korean Cancer Association. She sits on the Editorial Board for the Journal of Hepatology, and has published over 190 journal articles as a primary author in international peer-reviewed journals and contributed to several book chapters. She has been a frequent invited speaker over 170 times at academic conferences and education events across Asia and the world.