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Title: Consideration of role of radiotherapy for lymph node metastases in patients with HCC: Retrospective analysis for prognostic factors from 125 patients

Abstract

Objectives: To evaluate the role of radiotherapy (RT) for hepatocellular carcinoma (HCC) patients with abdominal lymph node (LN) metastasis at our institution in the past 7 years. Methods and Materials: We identified 125 patients with HCC metastasis to regional LNs treated with or without external beam RT (EBRT) between 1998 and 2004. Clinical characteristics collected included {alpha}-fetoprotein status, {gamma}-glutamyltransferase, status of intrahepatic tumors (size and number), previous therapy for intrahepatic tumors, metastatic LN status (location, number, and size), tumor thrombi, and Child-Pugh classification. Of the 125 patients, 62 received local limited EBRT and were classified as the EBRT group. They received locoregional LN irradiation. The tumor dose ranged from 40 to 60 Gy in daily 2.0-Gy fractions, 5 times weekly. Another 63 patients, who did not receive EBRT, were selected from hospitalized patients in the same period and were classified as the non-EBRT group. The parameters studied included survival rates and tumor response to EBRT both as demonstrated by clinical symptoms and as seen on CT. The Kaplan-Meier method was used to evaluate the survival rates, and the Cox regression model was used to identify predictors of outcome. Results: After EBRT, partial responses and complete responses were observed in 37.1%more » and 59.7% of patients, respectively. The median survival was 9.4 months (95% confidence interval 5.8-13.0) for the EBRT group and 3.3 months (95% confidence interval, 2.7-3.9) for the non-EBRT group (p < 0.001). Multivariate analysis showed that multiple intrahepatic primary tumors, occurrence of tumor thrombi, no therapy for intrahepatic tumors, and greater Child-Pugh classification were related to a poorer prognosis in all patients. In the EBRT group, the survival periods decreased as the distance of LN involvement from the liver increased (following the natural flow of lymph) and was also associated with the intrahepatic primary tumor size. The incidence of death resulting from LN-related complications was lower in the EBRT group. Conclusion: Lymph node metastasis from HCC is sensitive to EBRT. EBRT with 25 fractions of 2 Gy is an effective palliative treatment for patients with LN metastases from HCC presenting with good performance status and may prolong overall survival.« less

Authors:
 [1];  [2];  [2];  [2];  [2];  [2];  [2];  [3];  [4]
  1. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai (China). E-mail: ZCZeng@ZSHospital.net
  2. Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai (China)
  3. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai (China)
  4. Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai (China)
Publication Date:
OSTI Identifier:
20706250
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 63; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2005.03.058; PII: S0360-3016(05)00593-6; Copyright (c) 2005 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHILDREN; HEPATOMAS; IRRADIATION; LIVER; LYMPH; LYMPH NODES; METASTASES; PATIENTS; PERFORMANCE; RADIATION DOSES; RADIOTHERAPY; SYMPTOMS

Citation Formats

Zeng Zhaochong, Tang Zhaoyou, Fan Jia, Qin Lunxiu, Ye Shenlong, Zhou Jian, Sun Huichuan, Wang Binliang, and Wang Jianhua. Consideration of role of radiotherapy for lymph node metastases in patients with HCC: Retrospective analysis for prognostic factors from 125 patients. United States: N. p., 2005. Web. doi:10.1016/j.ijrobp.2005.03.058.
Zeng Zhaochong, Tang Zhaoyou, Fan Jia, Qin Lunxiu, Ye Shenlong, Zhou Jian, Sun Huichuan, Wang Binliang, & Wang Jianhua. Consideration of role of radiotherapy for lymph node metastases in patients with HCC: Retrospective analysis for prognostic factors from 125 patients. United States. doi:10.1016/j.ijrobp.2005.03.058.
Zeng Zhaochong, Tang Zhaoyou, Fan Jia, Qin Lunxiu, Ye Shenlong, Zhou Jian, Sun Huichuan, Wang Binliang, and Wang Jianhua. Tue . "Consideration of role of radiotherapy for lymph node metastases in patients with HCC: Retrospective analysis for prognostic factors from 125 patients". United States. doi:10.1016/j.ijrobp.2005.03.058.
@article{osti_20706250,
title = {Consideration of role of radiotherapy for lymph node metastases in patients with HCC: Retrospective analysis for prognostic factors from 125 patients},
author = {Zeng Zhaochong and Tang Zhaoyou and Fan Jia and Qin Lunxiu and Ye Shenlong and Zhou Jian and Sun Huichuan and Wang Binliang and Wang Jianhua},
abstractNote = {Objectives: To evaluate the role of radiotherapy (RT) for hepatocellular carcinoma (HCC) patients with abdominal lymph node (LN) metastasis at our institution in the past 7 years. Methods and Materials: We identified 125 patients with HCC metastasis to regional LNs treated with or without external beam RT (EBRT) between 1998 and 2004. Clinical characteristics collected included {alpha}-fetoprotein status, {gamma}-glutamyltransferase, status of intrahepatic tumors (size and number), previous therapy for intrahepatic tumors, metastatic LN status (location, number, and size), tumor thrombi, and Child-Pugh classification. Of the 125 patients, 62 received local limited EBRT and were classified as the EBRT group. They received locoregional LN irradiation. The tumor dose ranged from 40 to 60 Gy in daily 2.0-Gy fractions, 5 times weekly. Another 63 patients, who did not receive EBRT, were selected from hospitalized patients in the same period and were classified as the non-EBRT group. The parameters studied included survival rates and tumor response to EBRT both as demonstrated by clinical symptoms and as seen on CT. The Kaplan-Meier method was used to evaluate the survival rates, and the Cox regression model was used to identify predictors of outcome. Results: After EBRT, partial responses and complete responses were observed in 37.1% and 59.7% of patients, respectively. The median survival was 9.4 months (95% confidence interval 5.8-13.0) for the EBRT group and 3.3 months (95% confidence interval, 2.7-3.9) for the non-EBRT group (p < 0.001). Multivariate analysis showed that multiple intrahepatic primary tumors, occurrence of tumor thrombi, no therapy for intrahepatic tumors, and greater Child-Pugh classification were related to a poorer prognosis in all patients. In the EBRT group, the survival periods decreased as the distance of LN involvement from the liver increased (following the natural flow of lymph) and was also associated with the intrahepatic primary tumor size. The incidence of death resulting from LN-related complications was lower in the EBRT group. Conclusion: Lymph node metastasis from HCC is sensitive to EBRT. EBRT with 25 fractions of 2 Gy is an effective palliative treatment for patients with LN metastases from HCC presenting with good performance status and may prolong overall survival.},
doi = {10.1016/j.ijrobp.2005.03.058},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 63,
place = {United States},
year = {Tue Nov 15 00:00:00 EST 2005},
month = {Tue Nov 15 00:00:00 EST 2005}
}