Exploration of Superior Modality: Safety and Efficacy of Hypofractioned Image-Guided Intensity Modulated Radiation Therapy in Patients with Unresectable but Confined Intrahepatic Hepatocellular Carcinoma

الملخص EN

Purpose.

To evaluate the efficacy and safety of hypofractioned image-guided intensity modulated radiation therapy (IG-IMRT) for unresectable but confined intrahepatic hepatocellular carcinoma in comparison with conventional 3-dimensional conformal radiotherapy (3D-CRT).

Methods.

Ninety patients with unresectable but confined intrahepatic hepatocellular carcinoma without distant metastasis and tumor thrombosis received external beam radiation therapy.

Of these patients, 45 received IG-IMRT and 45 received 3D-CRT.

The IG-IMRT design delivered a median total hypofractionated dose of 54 Gy (2.2–5.5 Gy/fx), and 3D-CRT delivered a median total dose of 54 Gy with a conventional fraction (2.0 Gy/fx).

The clinical response, overall survival, and side effects were analyzed.

Results.

The IG-IMRT group showed significantly higher 1-year survival (93.3 versus 77.8%) and 2-year survival (73.3 versus 51.1%) and longer median survival (44.7 versus 24.0 months) than the 3D-CRT group.

Multivariate analysis indicated that the patients with intrahepatic tumors smaller than 8 cm, prior TACE before RT, and IG-IMRT would have a survival benefit.

There were no significant differences in the rates of side effects between the two groups.

Conclusion.

Hypofractioned IG-IMRT could improve the therapeutic response and confer a potential survival of patients with unresectable but confined intrahepatic hepatocellular carcinoma compared to 3D-CRT with acceptable toxicity.