Efficacy and prognostic factors of intensity-modulated radiotherapy for large primary hepatocellular carcinoma

Objective To investigate the efficacy of intensity- modulated radiotherapy( IMRT) in treating large primary hepatocellular carcinoma( LHCC) which is unsuitable for surgery or has poor response to radiofrequency ablation,interventional therapy,and other local treatments,and to identify the prognostic factors for survival. Methods We retrospectively analyzed the clinical data of 29 LHCC patients who received IMRT from April 2008 to August 2011. There were five fractions per week and the dose for each fraction was 2 to 6 Gy; the total dose was 50 to 70 Gy. The short- term efficacy and prognosis were observed and analyzed. The Kaplan- Meier method was used to calculate survival rates and the log- rank test was used for survival difference analysis. Multivariate analysis was performed using the Cox regression model. Results The complete remission,partial remission,stable disease,and disease progression rates were 3. 57%,32. 14%,53. 57%,and 10. 72%,respectively. The overall median progression- free survival( PFS) time was 6. 43 months,and the median overall survival( OS) time was 11. 43 months. The 1- and 2- year survival rates were 46. 79% and 25. 23%,respectively. Univariate analysis showed tumor response rate was an independent prognostic factor for PFS. The Cox proportional hazard model suggested the tumor response rate and prescribed dose were the independent prognostic factors for PFS. In addition,the independent prognostic factors for OS included tumor response rate,tumor diameter,and tumor volume. The common acute radiotherapy toxicities included gastrointestinal discomfort,radiation- induced liver damage,and myelosuppression. Conclusion IMRT is a safe and effective option for the LHCC patients who are unsuitable for surgery or in the cases that other local therapies fail.