Clinical Experiences of CK/HT in Hepatocellular Carcinoma

Clinical Experiences of CK/HT
in Hepatocellular Carcinoma
Chul-Seung Kay1,3 , Seok-Hyun Son1, Myung-Soo Kim1,
Jung-Hyun Kwon2
Department of Radiation Oncology1 & 2Internal Medicine2
3Catholic Comprehensive Hospital for Advanced Cancer3
Incheon St. Mary Hospital
The Catholic University of Korea

Contents
• The treatment outcome after CK
• The treatment outcome after HT
• The application of our data in HCC
• Ongoing investigation

• Retrospective study to evaluate the efficacy of SBRT for small non-resectable
HCC and SBRT combined with TACE for advanced HCC with PVTT
• 32 HCC lesions of 31 patients
- 23 lesions of 22 patients treated targeting small HCC
- 9 lesions of 9 patients targeting PVTT (all the patients received TACE for
advanced HCC)
• Median tumor volume was 25.2 ml (range, 3.6 ~ 57.3 ml)
• SBRT dose 30-39 Gy (median 36 Gy) in 3 fractions for consecutive days
• 75-85% of the PTV (GTV + 0.5cm)
Choi BO et al BMC cancer 8:351, 2008

Inclusion criteria
1. Histologically proven
2. Active enhancing HCC by CT
3. PVTT near the HCC
4. No extrahepatic mets
5. Max diameter ≤ 5cm
6. Age < 75 years old
7. HCC that did not developed
within transplanted liver
8. ECOG < 3
9. No prev Hx of RT
10. Wbc > 4000, PLT > 50,000
Median FU: 10.5 months
FU range: 2.0-18.5 months

Median Survival 1 year survival rate
Small HCC (n=22) 12 months 88.1%
PVTT (n=9) 8 months 43.2%
All (n=31) 11.5 months 81.4%

Toxicity
1. Grade 3 liver enzyme toxicity was in one
patient
2. Progression of CP class from A to B
within 3 months was in 5 patients. Three
of them had progressive disease in 1-2
months after SBRT
3. No progression from CP class B after
SBRT
4. No hematologic toxicity over grade 2
was found.
5. No grade 3 or greater GI toxicity
including nausea was found.
Choi et al BMC cancer 8:351, 2008

• Retrospective study to evaluate the long term effect of SBRT for primary small
HCC ineligible for local therapy or surgery
• 42 HCC patients with tumor < 100 ml (median tumor volume 15.4 ml; range, 3.0-
81.8ml)
• SBRT 30-39Gy/3fx/3days (median 80%, range 70-85%)
• median FU duration 28.7 months (range, 8.4-49.1 months)
Kwon JH et al BMC cancer 10:475, 2010

• Flow of study participant in the study

Kwon et al BMC cancer 10:475, 2010
a) A case of CR, b) a case of PR, c) a case of SD
•The dotted iosdosel line represents
GTV
•The green, yellow and purple curves
the 75, 70 and 10% isodose line,
respectively.
•36Gy was prescribed on the 75%
isodose line.
•Axial, coronal, and sagittal views and
DVH of the tumor and liver are
demonstarated

• Pattern of disease recurrence
CR; complete response
PD; progressive disease
28.6%
Intrahepatic PD; 59.5%

Son SH et al. Int J Radiat Oncol Biol Phys. 2010:78;1073-1080
• Identification of the parameters to predict hepatic toxicity and deterioration of
liver function
• Retrospective analysis of 47 small HCCs patients treated with CK
• Gross tumor volume 18.3±15.9cc (range, 3.0-81.3cc)
• Total dose 30-39 Gy/3fx (median 36 Gy)

Son SH et al. Int J Radiat Oncol Biol Phys. 2010:78;1073-1080

Jang JW et al. Int J Radiat Oncol Biol Phys. 2009:74;412-8
50 Gy/10 fractions/2 weeks

• Total 42 patients with HCC & extrahepatic metastases
• Total Number of lesions : 152 (3.5/person)
• Helical Tomotherapy for the lesions upto median 50Gy/10fx/2weeks
• TACL with epirubicin and CDDP for intrahepatic lesion following RT
• Overall response rate
* CR was achieved in 26.3% and 5.0% in pulmonary and adrenal metastases,
respectively.
• Overall survival rate at 1 year and 2 years : 50.1% and 14.9%
• Median survival : 12.3 months
• Acturial in-field control rate (within 1 year) : 79%
• No grade 4 or 5 treatment related toxicity
intrahepatic
tumor
pulmonary
metastases
LN/adrenal
metastases
soft tissue
metastases
45.2% 68.4% 60.0% 66.7%

6 months 12 months 18 months 24 months Median
OSR 75.2% 50.1% 19.9% 14.9% 12.3 months
OPF
S
42.7% 9.6% 10.5 months
IPFS 79.0% 61.5%
Helical Tomotherapy is safe and feasible without major toxicities for the
treatment of advanced HCC and results in excellent local control and a
potential survival benefit.

Kim JY et al Radiat Oncol 8:15, 2013

Inclusion criteria
1. Age > 18 yeas old
2. Tumor thrombosis in main and 1st or
2nd order branch of portal vein
3. 3 or less JIS score
4. Child-pugh class A or B
5. No extrahepatic metastases
6. Refractory or progressive disease
after previous treatment before
radiotherapy

Med OS 12.9 mo
2YSR 22.2%

• Identification of parameters predicting the deterioration of hepatic
function after HT in unresectable LAHCC
• Totally 72 patients
• Prescription dose : 50 Gy/10fx/2wks (range, 40-60Gy)
• RIHT was defined as an increase of at least 2 points in the CP score
within 3 months after completion of HT
Son SH et al Radiat Oncol 8:11, 2013

Cut off value 43.2%
Accuracy 0.806(58/72)
Sensitivity 0.938
Specificity 0.725

• 240 pts with HCC and extrahepatic metastasis (2004-2009)
• Local Tx : TACE, RT for intrahepatic tumor
• Tx for DM: metastasectomy, RT for metastasis
• RT : CFRT, Helical Tomotherapy, cyberknife)
• Favorable prognostic factors in multivariate analysis : CP class A, small size tumor, PVTT(-), single
metastasis, objective response of intrahepatic tumor after Tx
• Leading cause of death : progressive intrahepatic disease
• Even in advanced HCC with extrahepatic metastases, intrahepatic control is important in improving
patient survival
Jung SM et al. J Gastroenterol Hepatol 2012:27;684-9

CR+PR med S 521 days
SD+PD med S 170 days
(p<0.001)
Jung SM et al. J Gastroenterol Hepatol 2012:27;684-9
Survival according to intrahepatic tumor
response. Overall survival of 24 patients with
objective response was significantly improved,
with a median survival of 521 days, as
compared to 170 days in the 159 patients
without objective tumor response (p<0.001)

• To determine the α/β ratio for normal liver with hepatitis
• 98 patients with HCC treated with Helical Tomotherapy were eligible (200603-201202)
• Group A (n=66); 45-50Gy in 4.5-5 Gy fractions during 2wks
Group B (n=32); 36-60Gy in 2.5-3 Gy fractions during 3-6wks
• RIHT was defined as an increase of at least 2 points in CP score within 4 months after completion of
Helical Tomotherapy
• We attempt to find the statistically significant parameters in the 2 groups using α/β ratio of 2, 4, 6, 8 or
10 and compared the estimated probability curves of each parameter. We hypothesized that the α/β ratio
associated with the best matches for the curves between the 2 groups would be equivalent to the α/β
ratio for the normal liver with underlying hepatitis

Summary
• Hypofractionated radiotherapy using cyberkinfe or helical
tomothrapy was feasible and safe in inoperable
hepatocellular carcinma
• Even in extrahepatic disease, intrahepatic control may
lead the longer survival of patients. Radiotherapy was
effective treatment modality to achieve intrahepatic
disease control
• To predict RIHT defined as an increase at least 2 or
more CP score, the a/b ratio should be determined. We’d
like to suggest that the a/b ratio is 8, relatively higher
value than ever known.

Ongoing investigation
• Comparison of treatment outcomes by the difference of f
raction size in hypofractionated radiotherapy for the mod
erate size of Hepatocelluar Carcinoma (KCCH & CMC)
• Significance of an increase in Child-Pugh score after
radiotherapy in patients with unresectable hepatocellular
carcinoma (CMC)

Thank you for your attention !!

Clinical Experiences of CK/HT in Hepatocellular Carcinoma

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (8)

Similar to Clinical Experiences of CK/HT in Hepatocellular Carcinoma

Similar to Clinical Experiences of CK/HT in Hepatocellular Carcinoma (20)

Recently uploaded

Recently uploaded (20)