Clinical impact of carbon ion radiotherapy for hepatocellular carcinoma with Child-Pugh B cirrhosis
PO-1285
Abstract
Clinical impact of carbon ion radiotherapy for hepatocellular carcinoma with Child-Pugh B cirrhosis
Authors: Yuichi Hiroshima1, Masaru Wakatsuki2, Takashi Kaneko3, Hirokazu Makishima4, Hitoshi Ishikawa1, Hiroshi Tsuji5
1QST Hospital, National Institutes for Quantum Science and Technology, Radiotherapy, Chiba city, Japan; 2QST Hospital, National Institutes for Quantum Science and Technology, Radiotherpy, Chiba city, Japan; 3Yamagata University Hospital, Radiotherapy, Yamagata city, Japan; 4University of Tsukuba, Radiotherapy, Tsukuba city, Japan; 5QST Hospital, National Institutes for Quantum Science and Technology, Radiotherpay, Chiba city, Japan
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Purpose or Objective
The
purpose of this study is to evaluate the clinical efficacy of carbon ion
radiotherapy (CIRT) for hepatocellular carcinoma (HCC) in patients with group B
in the Child-Pugh classification.
Material and Methods
Fifty-eight
patients and 69 regions with HCC who received CIRT at our hospital from May
2000 to March 2020 were eligible for the study. Their median age was 71 years (range,
49-84), the number of men and women was 36 and 22, and performance status were
0/1/2 in 43/12/3 patients, respectively. The number of patients with a history
of HBV/HCV was 7/33, respectively, the median of tumor diameter was 3.2 cm
(range, 0.7-13.5 cｍ), and vascular invasion
was observed in 13 cases. Child-Pugh score was 7/8/9 in 42/13/3 patients, and
ALBI score was 1/2a/2b/3 in 1/7/46/4 patients, respectively. The median
follow-up period was 20.5 months (range, 2.3-108 months). Dose fractions were
45Gy (RBE)/2fraction (fr) in 9cases, 48Gy (RBE)/2fr in 24, 52.8Gy (RBE)/4fr in
27, and 60Gy (RBE)/4fr in 9, respectively.
Results
CIRT
has been completed as planned for all patients. Until now, 45 patients died,
and 43 patients had recurrences including locoregional ones and/or distant
metastasis. The 1- and 2- year rates of overall survival (OS), progression-free
survival and local recurrence-free rates were 80.4%/46.0%, 38.6%/6.9%,
96.4%/96.4%, respectively. During the observation period, hepatic Grade 3
adverse event of CTCAE was observed in one patient in the acute phase and two
patients in the late. No Grade 4 or higher adverse events were observed. The
Child-Pugh score worsened after CIRT in 24.1% of patients in the acute phase
and 39.7% in the late phase, but worsened from Child-Pugh score B to C in 1.7%
of patients in the acute phase and 5.2% in the late phase. In univariate
analysis, there was a significant difference in Child-Pugh score before CIRT in
OS (p=0.008). Regarding the influence of the worsening of Child-Pugh score after
CIRT on OS, worsening in the acute phase tended to deteriorate OS but difference
was not significant (p=0.157), while that in the late phase had significant influence
on OS (p<0.001).
Conclusion
CIRT
can be safe and effective for HCC even with poor hepatic function.