Concurrent chemoradiotherapy shows long-term survival after conversion from locally advanced to resectable hepatocellular carcinoma

Ik Jae Lee, Jun Won Kim, KwangHyub Han, Ja Kyung Kim, Kyung Sik Kim, Jin Sub Choi, Young Nyun Park, Jinsil Seong

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose: For locally unresectable hepatocellular carcinoma (HCC) patients, concurrent chemoradiotherapy (CCRT) has been applied as a loco-regional treatment. After shrinkage of tumors in selected patients, surgical resection is performed. The aim of this study was to evaluate prognostic factors and long-term survivors in such patients.

Materials and Methods: From January 2000 to January 2009, 264 patients with HCC were treated with CCRT (45 Gy with fractional dose of 1.8 Gy), and intra-arterial chemotherapy was administered during radiotherapy. Eighteen of these patients (6.8%) underwent hepatic resection after showing a response to CCRT. Cases were considered resectable when tumor-free margins and sufficient remnant volumes were obtained without extrahepatic metastasis. Prior to operation, there were six patients with complete remission, 11 with partial remission, and six with stable disease according to modified Response Evaluation Criteria in Solid Tumors.

Results: In pathologic review, four patients (22.2%) showed total necrosis and seven patients (38.9%) showed 70–99% necrosis. A high level of necrosis (≥80%) was correlated with low risk for extrahepatic metastasis and long-term survival. In univariate analyses, vessel invasion and capsular infiltration were significantly correlated with disease free survival (DFS) (p=0.017 and 0.013, respectively), and vessel invasion was significantly correlated with overall survival (OS) (p=0.013). In multivariate analyses, capsule infiltration was a significant factor for DFS (p=0.016) and vessel invasion was significant for OS (p=0.015).

Conclusion: CCRT showed favorable responses and locally advanced HCC converted into resectable tumor after CCRT in selected patients. Long-term survivors showed the pathological features of near total necrosis, as well as negative capsule and vessel invasion.

Original languageEnglish
Pages (from-to)1489-1497
Number of pages9
JournalYonsei medical journal
Volume55
Issue number6
DOIs
Publication statusPublished - 2014 Nov 1

Fingerprint

Chemoradiotherapy
Hepatocellular Carcinoma
Survival
Necrosis
Disease-Free Survival
Capsules
Survivors
Neoplasm Metastasis
Neoplasms
Radiotherapy
Multivariate Analysis
Drug Therapy
Liver

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Lee, Ik Jae ; Kim, Jun Won ; Han, KwangHyub ; Kim, Ja Kyung ; Kim, Kyung Sik ; Choi, Jin Sub ; Park, Young Nyun ; Seong, Jinsil. / Concurrent chemoradiotherapy shows long-term survival after conversion from locally advanced to resectable hepatocellular carcinoma. In: Yonsei medical journal. 2014 ; Vol. 55, No. 6. pp. 1489-1497.
@article{acb3503b79ca4b2395e94ce56ebbd5f8,
title = "Concurrent chemoradiotherapy shows long-term survival after conversion from locally advanced to resectable hepatocellular carcinoma",
abstract = "Purpose: For locally unresectable hepatocellular carcinoma (HCC) patients, concurrent chemoradiotherapy (CCRT) has been applied as a loco-regional treatment. After shrinkage of tumors in selected patients, surgical resection is performed. The aim of this study was to evaluate prognostic factors and long-term survivors in such patients.Materials and Methods: From January 2000 to January 2009, 264 patients with HCC were treated with CCRT (45 Gy with fractional dose of 1.8 Gy), and intra-arterial chemotherapy was administered during radiotherapy. Eighteen of these patients (6.8{\%}) underwent hepatic resection after showing a response to CCRT. Cases were considered resectable when tumor-free margins and sufficient remnant volumes were obtained without extrahepatic metastasis. Prior to operation, there were six patients with complete remission, 11 with partial remission, and six with stable disease according to modified Response Evaluation Criteria in Solid Tumors.Results: In pathologic review, four patients (22.2{\%}) showed total necrosis and seven patients (38.9{\%}) showed 70–99{\%} necrosis. A high level of necrosis (≥80{\%}) was correlated with low risk for extrahepatic metastasis and long-term survival. In univariate analyses, vessel invasion and capsular infiltration were significantly correlated with disease free survival (DFS) (p=0.017 and 0.013, respectively), and vessel invasion was significantly correlated with overall survival (OS) (p=0.013). In multivariate analyses, capsule infiltration was a significant factor for DFS (p=0.016) and vessel invasion was significant for OS (p=0.015).Conclusion: CCRT showed favorable responses and locally advanced HCC converted into resectable tumor after CCRT in selected patients. Long-term survivors showed the pathological features of near total necrosis, as well as negative capsule and vessel invasion.",
author = "Lee, {Ik Jae} and Kim, {Jun Won} and KwangHyub Han and Kim, {Ja Kyung} and Kim, {Kyung Sik} and Choi, {Jin Sub} and Park, {Young Nyun} and Jinsil Seong",
year = "2014",
month = "11",
day = "1",
doi = "10.3349/ymj.2014.55.6.1489",
language = "English",
volume = "55",
pages = "1489--1497",
journal = "Yonsei Medical Journal",
issn = "0513-5796",
publisher = "Yonsei University College of Medicine",
number = "6",

}

Concurrent chemoradiotherapy shows long-term survival after conversion from locally advanced to resectable hepatocellular carcinoma. / Lee, Ik Jae; Kim, Jun Won; Han, KwangHyub; Kim, Ja Kyung; Kim, Kyung Sik; Choi, Jin Sub; Park, Young Nyun; Seong, Jinsil.

In: Yonsei medical journal, Vol. 55, No. 6, 01.11.2014, p. 1489-1497.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Concurrent chemoradiotherapy shows long-term survival after conversion from locally advanced to resectable hepatocellular carcinoma

AU - Lee, Ik Jae

AU - Kim, Jun Won

AU - Han, KwangHyub

AU - Kim, Ja Kyung

AU - Kim, Kyung Sik

AU - Choi, Jin Sub

AU - Park, Young Nyun

AU - Seong, Jinsil

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Purpose: For locally unresectable hepatocellular carcinoma (HCC) patients, concurrent chemoradiotherapy (CCRT) has been applied as a loco-regional treatment. After shrinkage of tumors in selected patients, surgical resection is performed. The aim of this study was to evaluate prognostic factors and long-term survivors in such patients.Materials and Methods: From January 2000 to January 2009, 264 patients with HCC were treated with CCRT (45 Gy with fractional dose of 1.8 Gy), and intra-arterial chemotherapy was administered during radiotherapy. Eighteen of these patients (6.8%) underwent hepatic resection after showing a response to CCRT. Cases were considered resectable when tumor-free margins and sufficient remnant volumes were obtained without extrahepatic metastasis. Prior to operation, there were six patients with complete remission, 11 with partial remission, and six with stable disease according to modified Response Evaluation Criteria in Solid Tumors.Results: In pathologic review, four patients (22.2%) showed total necrosis and seven patients (38.9%) showed 70–99% necrosis. A high level of necrosis (≥80%) was correlated with low risk for extrahepatic metastasis and long-term survival. In univariate analyses, vessel invasion and capsular infiltration were significantly correlated with disease free survival (DFS) (p=0.017 and 0.013, respectively), and vessel invasion was significantly correlated with overall survival (OS) (p=0.013). In multivariate analyses, capsule infiltration was a significant factor for DFS (p=0.016) and vessel invasion was significant for OS (p=0.015).Conclusion: CCRT showed favorable responses and locally advanced HCC converted into resectable tumor after CCRT in selected patients. Long-term survivors showed the pathological features of near total necrosis, as well as negative capsule and vessel invasion.

AB - Purpose: For locally unresectable hepatocellular carcinoma (HCC) patients, concurrent chemoradiotherapy (CCRT) has been applied as a loco-regional treatment. After shrinkage of tumors in selected patients, surgical resection is performed. The aim of this study was to evaluate prognostic factors and long-term survivors in such patients.Materials and Methods: From January 2000 to January 2009, 264 patients with HCC were treated with CCRT (45 Gy with fractional dose of 1.8 Gy), and intra-arterial chemotherapy was administered during radiotherapy. Eighteen of these patients (6.8%) underwent hepatic resection after showing a response to CCRT. Cases were considered resectable when tumor-free margins and sufficient remnant volumes were obtained without extrahepatic metastasis. Prior to operation, there were six patients with complete remission, 11 with partial remission, and six with stable disease according to modified Response Evaluation Criteria in Solid Tumors.Results: In pathologic review, four patients (22.2%) showed total necrosis and seven patients (38.9%) showed 70–99% necrosis. A high level of necrosis (≥80%) was correlated with low risk for extrahepatic metastasis and long-term survival. In univariate analyses, vessel invasion and capsular infiltration were significantly correlated with disease free survival (DFS) (p=0.017 and 0.013, respectively), and vessel invasion was significantly correlated with overall survival (OS) (p=0.013). In multivariate analyses, capsule infiltration was a significant factor for DFS (p=0.016) and vessel invasion was significant for OS (p=0.015).Conclusion: CCRT showed favorable responses and locally advanced HCC converted into resectable tumor after CCRT in selected patients. Long-term survivors showed the pathological features of near total necrosis, as well as negative capsule and vessel invasion.

UR - http://www.scopus.com/inward/record.url?scp=84908224169&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908224169&partnerID=8YFLogxK

U2 - 10.3349/ymj.2014.55.6.1489

DO - 10.3349/ymj.2014.55.6.1489

M3 - Article

C2 - 25323884

AN - SCOPUS:84908224169

VL - 55

SP - 1489

EP - 1497

JO - Yonsei Medical Journal

JF - Yonsei Medical Journal

SN - 0513-5796

IS - 6

ER -