Sequential transcatheter arterial chemoembolization, three-dimensional conformal radiotherapy, and high-intensity focused ultrasound treatment for unresectable hepatocellular carcinoma patients

Abstract

The purpose of this study was to evaluate the outcome of patients with unresectable hepatocellular carcinoma (HCC) treated by sequential therapy of transcatheter arterial chemoembolization (TACE), three-dimensional conformal radiotherapy (3-DCRT) and high-intensity focused ultrasound (HIFU). From October, 2005 to September, 2010, 120 patients with unresectable HCC received the sequential treatments of several courses of TACE followed in 2-4 weeks by 3-DCRT and then a single session of HIFU with a curative intent. The median tumor irradiation dose was 40 Gy. Tumor response, toxicity and overall survival rate were analyzed. Clinicopathologic factors affecting the primary technique effectiveness and overall survival rates were investigated by univariate analysis or multivariate analysis. All 120 HCC patients were followed up by the last follow-up time. Among these patients, hepatic toxicities due to treatment were notable in 9 cases. Gastrointestinal bleeding after the overall treatment occurred in 2 cases, leukopenia of grade III was detected in 1 case, radiation-induced liver disease (RILD) was observed in 2 patients, and first- and second-degree skin burn around the HIFU treatment zone were observed in 2 patients and 1 patient, respectively. Among 120 patients, 23, 83 and 14 cases achieved partial response, stable disease and progressive disease, respectively. The overall survival rates at 1 year, 3 years and 5 years were 70%, 35% and 15%, respectively, with a median survival time of 26 months. Both Child-Pugh liver function grading and radiation dose were determined to be independent predictors for overall survival revealed by the multivariate analysis. It is concluded that the sequential therapy of TACE, 3-DCRT and HIFU is a promising therapeutic regimen for unresectable HCC.

Keywords: hepatocellular carcinoma; high-intensity focused ultrasound (HIFU); three-dimensional con-formal radiotherapy (3-DCRT); transcatheter arterial chemoembolization (TACE).

Fig. 1. Kaplan-Meier survival estimates of 120 hepatocellular carcinoma (HCC) patients.

A: The overall survival rates of 120 HCC patients treated by sequential therapy of TACE, 3-DCRT and HIFU. The effect on various prognostic factors including gender (B), age (C), Child-Pugh grade (D), HBV (E), Barcelona Clinic Liver Cancer (BCLC) stage (F), TACE times (G), radiation dose (H), alpha-fetoprotein (AFP) (I), and HIFU times (J) on survival.