RESUMO
PURPOSE: To evaluate the effects of dose escalation by intensity-modulated radiotherapy (IMRT) in liver-directed concurrent chemoradiotherapy for locally advanced Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma (BCLC-C HCC). MATERIALS AND METHODS: During 2005-2016, 637 patients with BCLC-C HCC received RT with concurrent hepatic arterial 5-fluorouracil. Patients were divided into two groups according to the biologically effective doses for a tumor (α/ßâ¯=â¯10â¯Gy): <72â¯Gy (536 patients) and ≥72â¯Gy (101 patients). In each group, 128/536 (24%) and 94/101 patients (93%) used IMRT, respectively. RESULTS: The median follow-up for patients alive at the time of analysis was 36â¯months (range, 6-159â¯months). For ≥72â¯Gy and <72â¯Gy groups, the median overall survival (OS) was 21 and 13â¯months, respectively (Pâ¯=â¯.002). The 1-year local failure-free survival (LFFS) were significantly higher in high-dose group (95% vs. 79%; Pâ¯<â¯.001). After propensity score matching, high-dose group still had significantly better 1-year OS (62% vs. 51%; Pâ¯=â¯.03) and 1-year LFFS (95% vs. 78%; Pâ¯=â¯.008). In the multivariate model, RT dose was an independent predictor of LFFS and OS. The surgical conversion rate was significantly higher in high-dose group (20% vs. 12%, Pâ¯=â¯.03), with substantially increased median OS among patients who underwent surgery (104â¯months vs. 11â¯months; Pâ¯<â¯.001). There were no significant differences in gastrointestinal bleeding or radiation-induced liver disease. CONCLUSIONS: In liver-directed concurrent chemoradiotherapy, radiation dose escalation by IMRT increased LFFS and OS for locally advanced BCLC-C HCC. It also increased the conversion rate to curative resection, which was attributable to increased OS.