Image-guided intensity-modulated radiotherapy improves short-term survival for abdominal lymph node metastases from hepatocellular carcinoma

Haige Zhang, Yixing Chen, Yong Hu, Ping Yang, Binliang Wang, Jianying Zhang, Jing Sun, Zhaochong Zeng


Background: Radiotherapy (RT) is an effective treatment for hepatocellular carcinoma (HCC) patients with lymph node metastasis (LNM), which is a rare clinical situation with a poor prognosis. We evaluated the responses and toxicities in HCC patients with abdominal LNM treated with either image-guided intensity- modulated radiotherapy (IG-IMRT) or non-IG-IMRT.
Methods: Retrospective review of the records of HCC patients with regional LNM treated with IG-IMRT (n=43) or non-IG-IMRT (n=42). The tumor responses, local control rates (LCRs), overall survival (OS) rates, and toxicities were evaluated.
Results: The mean biological effective dose with α/β =10 Gy (BED10) delivered to IG-IMRT group was 67.23±8.48 vs. 63.43±5.01 Gy delivered to non-IG-IMRT group (P=0.008). OS in IG-IMRT group vs. non- IG-IMRT group was 15.3 vs. 9.7 months (P=0.098). The one-year survival of IG-IMRT group was superior (69% vs. 38.1% for non-IG-IMRT, P=0.006). Whereas two-year survival was not significantly different. Negative independent prognostic factors included ≥2 positive lymph nodes and previous treatment without surgery, while BED10 ≥65 Gy was a protective factor. Toxicities were mild for both groups, while IG-IMRT group showed less late hepatotoxicity.
Conclusions: The therapeutic dose delivered by IG-IMRT is slightly higher than non-IG-IMRT which was more effective and showed superior short-term survival and local control in HCC patients with LNM.