Effects of radiotherapy combined with transcatheter arterial chemoembolization on patients with advanced unresectable primary hepatocellular carcinoma

Objective To evaluate the effects of transcatheter arterial chemoembolization(TACE) combined with radiation therapy on patients with advanced unresectable primary hepatocellular carcinoma(PHC).Methods From July 2005 to June 2008,108 patients with advanced unresectable PHC were divided into 2 groups.Fifty patients were treated with linear accelerator combined with TACE(accelerator group),and 58 patients were treated with body gamma knife combined with TACE(gamma knife group).For accelerator group,6MV-X ray was used,≥95% isodose included PTV,and the total treatment dosage was 40-60Gy with 3-5 times per week.For gamma knife stereotaxis radiation therapy,the planning of treatment was 3-6Gy per-fraction,3-5 times per week and the total treatment dosage was 30-50Gy.For TACE,10-20mg mitomycin,1000-1500mg fluorouracil and 30-50mg epirubicine were perfused into the hepatic arteries,5-20ml mioldized oil were given to emobolized the hepatic arteries,and each patient was treated with 1-3 sessions.Results For accelerator group and gamma knife group,the median survival time were 14 months and 16 months,and the median time-to-progression were 7.6 months and 8.1 months.The 2-year local control rates were 45.4% and 43.6%,and the 3-year local control rates were 36.5% and 37.9% respectively.There was no statistical significant difference between 2 groups(χ2=0.020,P=0.887;χ2=0.040,P=0.841).For accelerator group,2-and 3-year overall survival rates were 41.1% and 39.6%,respectively.For gamma knife group,they were 34.3% and 30.2%,respectively.There was not significant difference in 2-and 3-year survival rates between 2 groups(χ2=0.021,P=0.885;χ2=0.368,P=0.544).Accelerator group was found 1 case with radiation induced liver disease(RILD),while RILD in gamma knife group was not found.Conclusion The efficacy and toxicity of TACE combined with linear accelerator or gamma knife for advanced unresectable PHC were similar.