Radiation therapy for abdominal lymph node metastasis from hepatocellular carcinoma

Background: We report the results of radiotherapy for abdominal lymph node metastasis from hepatocellular carcinoma (HCC). Methods: From 1998 to 2004, 45 cases were treated with radiotherapy (RT), with a dose between 30 and 55 Gy. The radiation response, overall survival, prognostic factors, and complications were evaluated. Results: Thirty-nine cases were able to be evaluated for response: 10 cases showed complete response; 21 cases showed a partial response; and 8 cases showed stable disease. The overall response rate was 79.5%. The response rate was 87.5% for patients receiving ≥40 Gy₁₀ (biologically effective dose, α/β = 10) and 42.9% for patients receiving ≥40 Gy₁₀ (P = 0.02). The median survival time was 10 months for responders and 6 months for nonresponders (P = 0.01). The absence of other concurrent distant metastasis and controllable primary HCC were significant prognostic factors. RT induced gastric or duodenal ulcer development in nine patients. All of these patients had received more than 50 Gy₁₀, and these complications were not detected among patients receiving <50 Gy₁₀ (0% vs 37.5%, P < 0.01). Conclusions: RT was an effective treatment modality, and the absence of concurrent distant metastasis and controllable primary tumor were significant prognostic factors. However, considering the high rate of RT-induced morbidity, 40 Gy₁₀ to 50 Gy₁₀ might be the optimal RT dose.