Objective: To evaluate the outcomes of patients with unresectable massive primary liver cancer (PLC) receiving three-dimensional conformal radiotherapy (3-DCRT) combined with transcatheter arterial chemoembolization (TACE).
Methods: From January 2001 to December 2004, 84 patients with unresectable massive PLC (tumor size> or =10 cm) received 3-DCRT combined with TACE, including 49 cases in UICC/AJCC T(3) stage and 35 cases in T(4) stages. Lymph node metastasis was found in none of the patients, and portal vein tumor thrombosis (PVTT) was detected in 30 cases. Child-Pugh grade A of liver cirrhosis was present in 64 cases and grade B in 20 cases. The mean value of GTV was 705-/+430 cm(3) (170-2099 cm(3)). Following injections of fluorouracil and hydroxycamptothecine into the target artery of the tumor, the mixture of carboplatin, mitomycin (or pirarubicin) and super-liquefactive iodized oil was injected into the target artery. Gelatin sponge was used to embolize the artery. The procedure was repeated every 1.5-2 months according to the condition of the patients, and each patient received 1-3 such procedures. 3-DCRT was performed in all the patients, who received a total dose of 53.6-/+6.6 Gy (4-6 Gy per fraction at the interval of 48 h), and 3 fractions were given every week.
Results: Eight patients died in 3 months after 3-DCRT and were not evaluated. The total response rate (CR+PR) in these patients was 68.9% (51/74). The overall survival rates at 1, 2 and 3 years were 55.4%, 24.7% and 15.4%, respectively. T stage, GTV, PVTT and fraction size had no significant impact on the overall survival. Child-Pugh grade was found to have significant impact on the patients' survival (P=0.035, RR=2.440).
Conclusion: 3-DCRT combined with TACE has definite therapeutic effect on advanced massive PLC, and Child-Pugh grade is an independent prognostic factor in such cases.