Cancer Research and Treatment

Original Articles

Do Biliary Complications after Hypofractionated Radiation Therapy in Hepatocellular Carcinoma Matter?: Jeong Il Yu, Hee Chul Park, Do Hoon Lim, Seung Woon Paik; Cancer Res Treat. 2016;48(2):574-582. Published online July 17, 2015; DOI: https://doi.org/10.4143/crt.2015.076

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Purpose
The purpose of this study is to evaluate the efficacy of hypofractionated radiation therapy (RT) in the treatment of unresectable hepatocellular carcinoma (HCC) after failure of transarterial chemoembolization (TACE) or in cases of refractory HCC, and to investigate biliary complications after hypofractionated RT. Materials and Methods We retrospectively enrolled patients with unresectable, TACE-unresponsive, or refractory HCC treated with hypofractionated RT between July 2006 and December 2012. The perihilar region was defined as the 1-cm area surrounding the right, left, and the common hepatic duct, including the gallbladder and the cystic duct. Significant elevation of total bilirubin was defined as an increase of more than 3.0 mg/dL, and more than two times that of the previous level after completion of RT.
Results
Fifty patients received hypofractionated RT and 27 (54%) had a tumor located within the perihilar region. The median follow-up period was 24.7 months (range, 4.3 to 95.5 months). None of the patients developed classic radiation disease symptoms, but four patients (8%) showed significant elevation of total bilirubin within 1 year after RT. During follow-up, 12 patients (24%) developed radiologic biliary abnormalities, but only two patients had toxicities requiring intervention. Estimated local progression-free survival, progression-free survival, and overall survival of the patients at 3-year post-hypofractionated RT were 89.7%, 11.2%, and 57.4%, respectively. Conclusion Biliary complications associated with a higher dose exposure of hypofractionated RT were minimal, even in the perihilar region. Hypofractionated RT provided excellent local control and may be a valuable option for treatment of unresectable cases of TACE-unresponsive or refractory HCC.

Citations

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Comparative analysis of clinical treatment outcomes: Breath‐hold vs. free‐breathing techniques in liver stereotactic body radiotherapy
Kosuke Morishima, Hideomi Yamashita, Tomoyuki Noyama, Atsuto Katano
Journal of Medical Imaging and Radiation Oncology.2025; 69(1): 136. CrossRef
Clinical outcomes and safety of external beam radiotherapy with extensive intrahepatic targets for advanced hepatocellular carcinoma: A single institutional clinical experience
Sunmin Park, Chai Hong Rim, Won Sup Yoon
Saudi Journal of Gastroenterology.2024; 30(6): 399. CrossRef
Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 4: Liver and locally recurrent rectal cancer
Hwa Kyung Byun, Gyu Sang Yoo, Soo-Yoon Sung, Jin-Ho Song, Byoung Hyuck Kim, Yoo-Kang Kwak, Yeon Joo Kim, Yeon-Sil Kim, Kyung Su Kim
Radiation Oncology Journal.2024; 42(4): 247. CrossRef
Pencil Beam Scanning Carbon Ion Radiotherapy for Hepatocellular Carcinoma
Wenna Zhang, Xin Cai, Jiayao Sun, Weiwei Wang, Jingfang Zhao, Qing Zhang, Guoliang Jiang, Zheng Wang
Journal of Hepatocellular Carcinoma.2023; Volume 10: 2397. CrossRef
Hypofractionation in Hepatocellular Carcinoma – The Effect of Fractionation Size
S. Lewis, A. Barry, M.A. Hawkins
Clinical Oncology.2022; 34(5): e195. CrossRef
Potential of novel colchicine dosage schedule for the palliative treatment of advanced hepatocellular carcinoma
Zu‐Yau Lin, Ming‐Lun Yeh, Ching‐I Huang, Shinn‐Cherng Chen, Chung‐Feng Huang, Jee‐Fu Huang, Chia‐Yen Dai, Ming‐Lung Yu, Wan‐Long Chuang
The Kaohsiung Journal of Medical Sciences.2021; 37(7): 616. CrossRef
The feasibility of transcatheter arterial chemoembolization following radiation therapy for hepatocellular carcinoma
Mostafa Hamada, Eisuke Ueshima, Takeaki Ishihara, Yutaka Koide, Takuya Okada, Hiroki Horinouchi, Jun Ishida, Hiroshi Mayahara, Koji Sasaki, Tomoyuki Gentsu, Keitaro Sofue, Masato Yamaguchi, Ryohei Sasaki, Koji Sugimoto, Takamichi Murakami
Acta Radiologica Open.2021;[Epub] CrossRef
Stereotactic body radiation therapy vs. radiofrequency ablation in Asian patients with hepatocellular carcinoma
Nalee Kim, Jason Cheng, Inkyung Jung, Ja Der Liang, Yu Lueng Shih, Wen-Yen Huang, Tomoki Kimura, Victor H.F. Lee, Zhao Chong Zeng, Ren Zhenggan, Chul Seung Kay, Seok Jae Heo, Jong Yoon Won, Jinsil Seong
Journal of Hepatology.2020; 73(1): 121. CrossRef
Do Biliary Complications after Proton Beam Therapy for Perihilar Hepatocellular Carcinoma Matter?
Gyu Sang Yoo, Jeong Il Yu, Hee Chul Park, Dongho Hyun, Woo Kyoung Jeong, Ho Yeong Lim, Moon Seok Choi, Sang Yun Ha
Cancers.2020; 12(9): 2395. CrossRef
Clinical significance of radiotherapy before and/or during nivolumab treatment in hepatocellular carcinoma
Jeong Il Yu, Su Jin Lee, Jeeyun Lee, Ho Yeong Lim, Seung Woon Paik, Gyu Sang Yoo, Changhoon Choi, Hee Chul Park
Cancer Medicine.2019; 8(16): 6986. CrossRef
Is higher dose always the right answer in stereotactic body radiation therapy for small hepatocellular carcinoma?
Kyung Hwa Lee, Jeong Il Yu, Hee Chul Park, Su Yeon Park, Jung Suk Shin, Eun Hyuk Shin, Sungkoo Cho, Sang Hoon Jung, Young Yih Han, Do Hoon Lim
Radiation Oncology Journal.2018; 36(2): 129. CrossRef
Proton therapy for hepatocellular carcinoma: Current knowledges and future perspectives
Gyu Sang Yoo, Jeong Il Yu, Hee Chul Park
World Journal of Gastroenterology.2018; 24(28): 3090. CrossRef
The possibility of radiotherapy as downstaging to living donor liver transplantation for hepatocellular carcinoma with portal vein tumor thrombus
Jin Y. Choi, Jeong I. Yu, Hee C. Park, C. H. David Kwon, Jong M. Kim, Jae‐Won Joh, Gyu‐Seong Choi, Jae B. Park, Sung J. Kim, Seung H. Lee, Won‐Tae Cho, Kyo W. Lee, Byeong‐Gon Na, Dong Kyu Oh, Nuri Lee, Chan W. Cho, Sanghoon Lee, Suk‐Koo Lee
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Bruno Sangro, Diego Martínez‐Urbistondo, Lourens Bester, Jose I. Bilbao, Douglas M. Coldwell, Patrick Flamen, Andrew Kennedy, Jens Ricke, Ricky A. Sharma
Hepatology.2017; 66(3): 969. CrossRef

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Changes in Arterioportal Shunts in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis Who Were Treated with Chemoembolization Followed by Radiotherapy: Dongryul Oh, Sung Wook Shin, Hee Chul Park, Sung Ki Cho, Do Hoon Lim, Seung Woon Paik; Cancer Res Treat. 2015;47(2):251-258. Published online October 27, 2014; DOI: https://doi.org/10.4143/crt.2014.011

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Purpose
In this study, we retrospectively investigated the prevalence of arterioportal (AP) shunts in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and evaluated the changes in AP shunts after chemoembolization followed by external beam radiation therapy (EBRT).
Materials and Methods
We analyzed 54 HCC patients with PVTT who were treated with chemoembolization followed by EBRT. EBRT was uniformly delivered at a total dose of 30 to 45 Gy (median, 35 Gy), with a daily dose of 2 to 4.5 Gy. Angiographic images of chemoembolization before and after radiation therapy (RT) were reviewed to investigate the AP shunt.
Results
During the initial session of chemoembolization, 33 of 54 patients (61%) had an AP shunt. After EBRT, 32 out of 33 patients had an additional session of chemoembolization and were evaluated for a change in the AP shunt. The AP shunt decreased in 20 of 32 patients (63%) after chemoembolization followed by EBRT. The 1-year calculated overall survival (OS) rate for all patients was 52.6% and the 2-year OS was 36.4%. The median OS in all patients was 13 months. Patients with AP shunt showed poorer median OS than those without AP shunt, but there was no statistically significant difference (median, 12 months vs. 17 months).
Conclusion
The AP shunt frequently occurs in HCC patients with PVTT. This study suggests that a poor prognosis is associated with an AP shunt. Chemoembolization followed by RT may produce a decrease in AP shunts.

Citations

Citations to this article as recorded by

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Drug-eluting beads TACE is safe and non-inferior to conventional TACE in HCC patients with TIPS
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European Radiology.2021; 31(11): 8291. CrossRef
Diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging after radiation therapy for bone metastases in patients with hepatocellular carcinoma
Ji Hyun Lee, Gyu Sang Yoo, Young Cheol Yoon, Hee Chul Park, Hyun Su Kim
Scientific Reports.2021;[Epub] CrossRef
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Yao-chang Luo, Hai-lin Lu, Wen-ling Song, Fei-fei Xuan
Journal of International Medical Research.2021;[Epub] CrossRef
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Hai-lin Lu, Fei-fei Xuan, Yao-chang Luo, Xiao Qin
Abdominal Radiology.2021; 46(11): 5417. CrossRef
Portal stent with endovascular brachytherapy improves the efficacy of TACE for hepatocellular carcinoma with main portal vein tumor thrombus
Tian Li, Chong Liu, Jin-Tong He, Kai-Da Sui, Zhou-Bo Zhang, Duo Hong, Hong-Ying Su, Hai-Bo Shao
Hepatobiliary & Pancreatic Diseases International.2020; 19(2): 187. CrossRef
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Philippe d'Abadie, Ivan Borbath, Pierre Goffette, Nadia Amini, Renaud Lhommel
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Clinical impact of combined transarterial chemoembolization and radiotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: An external validation study
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Dose-Response Relationship of Radiotherapy for Locally Advanced Hepatocellular Carcinoma: Dae Yong Kim, Joon Hyoek Lee, Kwang Cheol Koh, Seung Woon Paik, Yong Chan Ahn, Seung Jae Huh, Inhwan J Yeo, Suk Won Park, Seung Hee Chang; J Korean Cancer Assoc. 2000;32(5):918-924.

Abstract PDF: PURPOSE
Recently radiotherapy is applied alone or in conjunction with transcatheter arterial chemoembolizaion (TACE) or percutaneous ethanol injection therapy (PEIT) for locally advanced hepatocellular carcinoma (HCC). The purpose of this study was to evaluate dose-response relationship of radiotherapy for local control and toxicity in inoperable HCC.
MATERIALS AND METHODS
Twenty-eight patients who were not eligible for TACE and PEIT or had showed no response to these treatment were treated with a total dose of 40 Gy with 2 Gy per fraction or 30 Gy with 3 Gy per fraction (low dose group, 18 patients) or 45 Gy with 3 Gy per fraction (high dose group, 10 patients).
RESULTS
The median survival duration was 8 months and 1-year survival rate was 37%. The treatment results were as follows; partial response in 11% and 70% (p=0.001), stable disease in 56% and 30%, and progressive disease in 33% and 0% in low dose group and high dose group, respectively. The incidence of gastrointestinal (G-I) toxicity by the criteria of Southwest Oncology Group was as follows; grade 1 in 22% and 40%, grade 2 in 17% and 10%, respectively (p=0.56). There was no patient with severe G-I toxicity above grade 3. The incidence of G-I toxicity by site was as follows; grade 1 in 24% and 29%, and grade 2 in 0% and 57% in patients with right lobe and left lobe lesion, respectively (p=0.001).
CONCLUSION
This study indicates that there is clear dose-response relationship in local control. The G-I toxicity does not increase significantly with increment of radiation dose within the dose range tested in this study. And careful attention should be paid for G-I toxicity when the tumor is located in left lobe.

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