The efficacy of high-dose 3-dimensional conformal radiation therapy in patients with small hepatocellular carcinoma not eligible for other local modalities

PURPOSE: To analyze the efficacy and toxicity of high-dose 3-dimensional conformal radiation therapy (3D-CRT) for patients with small hepatocellular carcinoma (HCC) not eligible for other local modalities. METHODS: Between 1998 and 2006, 61 patients with small HCC were treated with high-dose 3D-CRT. The eligibility criteria were as follows: (1) HCC <5 cm; (2) HCC without vascular invasion; (3) HCC without extrahepatic metastasis; and (4) not eligible for other local modalities. The median RT dose was 54 Gy (range, 36 to 55 Gy) daily in 2.5 to 5 Gy fractions. We evaluated tumor response, local control, overall survival, pattern of failure, and toxicity. RESULTS: The median follow-up period was 16.7 months. Tumor response was 68.9% (42 of 61 lesions) with a complete response in 27 lesions (44.3%). Local control was 93.8% at 1 year and 86.9% at 3 years. Intrahepatic metastases developed in 40 patients (65.6%). Thirteen patients (22.3%) had extrahepatic metastasis. The median survival was 56 months (range, 2.8 to 68.1 mo), and the overall survival rate was 81.1% at 1 year and 58.4% at 3 years. Three patients developed radiation-induced liver disease, but there were no instances of grade 3 or higher toxicity. CONCLUSIONS: High-dose 3D-CRT for small HCC <5 cm showed favorable local control and overall survival without serious complications. RT might be an effective local modality in patients with small HCC not eligible for other local modalities.