Analysis Of The Efficacy And Prognosis Of Intensity-modulated Radiotherapy In Advanced Unresectable Hepatocellular Carcinoma

Objective:To explore the clinical efficacy,adverse reactions and related factors affecting the efficacy and prognosis of intensity-modulated radiotherapy in advanced unresectable hepatocellular carcinoma.Methods:Forty-two patients with advanced unresectable hepatocellular carcinoma who were met the clinical diagnostic criteria established by the Ministry of Health of the People’s Republic of China or were diagnosed through multi-disciplinary treatment(MDT)outpatient discussion of the liver admitted to the Department of Oncology,Subei People’s Hospital,between January 2018 and January 2021.To retrospectively analyze the clinical efficacy of intensity-modulated radiotherapy in advanced unresectable hepatocellular carcinoma,adverse effects and associated factors affecting the efficacy and prognosis.All patients were treated with intensity-modulated radiotherapy for liver lesions at a total dose of 50Gy,with a single dose of 2Gy,five times a week.MRI or CT imaging of the abdomen was performed 1～3 months after the completion of radiotherapy to assess the efficacy.According to the response evaluation criteria in solid tumors version 1.1,the recent efficacy evaluation was divided into effective and ineffective groups,with the effective group defined as complete remission plus partial remission and the ineffective group defined as stable disease plus progression disease.Single factor and Cox regression multivariate analysis were performed on the two treatment efficacy groups to analyze the related factors of radiotherapy efficacy and the independent factors of prognosis.The Kaplan-Meier statistic was used to calculate 6-month,1-year and 2-year survival rates and the overall survival time of the two groups of patients with curative effect was compared and analyzed.Hematological tests were performed weekly during radiotherapy and within 3 months after radiotherapy,and safety was assessed using National Cancer Institute Common Toxicity Criteria(NCI-CTC).Results:All the 42 patients with advanced unresectable hepatocellular carcinoma completed the radiotherapy plan.The last follow-up time was from January 2021,with a follow-up time of 3.0 to 26.5 months and a median follow-up time of 9.0 months.Twenty-seven patients were followed up for more than half a year,and eight patients were followed up for more than a year.No patients were lost to follow-up.According to the results of abdominal MRI or CT,combined with RECIST 1.1 criteria for efficacy evaluation,3(7.1%)of the 42 patients achieved complete remission,15(35.7%)achieved partial remission,16(38.0%)achieved stable disease and 8(19.0%)achieved progression disease,with an objective The objective response rate(ORR)=(CR+PR)42.8%,disease control rate(DCR)=(CR+PR+SD)80.9%.The median overall survival was 10.1 months and the median progression-free survival was 5.4 months.The six-month,one-year and two-year survival rates of all patients were 64.3%,19.0%and 0%,respectively.The recent efficacy of radiotherapy was evaluated in 18 cases in the effective group and 24 cases in the ineffective group.The median OS in the effective group was 13.2 months and that in the ineffective group was 5.2 months.In univariate analysis between the effective group and the ineffective group,it was found that tumor diameter,whether accompanied with venous cancer thrombus,whether combined intervention,whether combined targeting,whether combined immunization,and alpha fetoprotein after radiotherapy were related factors affecting the efficacy of radiotherapy(P<0.05).Multivariate analysis showed that the presence of portal vein tumor thrombus(P=0.003),tumor diameter(P=0.013),and combined targeting(P=0.005)were independent factors affecting the prognosis of patients with advanced unresectable hepatocytes.The most common adverse reactions during and after radiotherapy were hypoalbuminemia in 16 cases(38.0%),elevated transaminases in 12 cases(28.5%)and hyperbilirubinemia in 12 cases(28.5%).Grade 3 or higher adverse events included one case of nausea and vomiting,one case of elevated transaminases,two cases of hypoalbuminemia,one case of thrombocytopenia,one case of hyperbilirubinemia and one case of elevated alkaline phosphatase.One patient with partial remission developed radiation-induced liver damage(RILD)during the follow-up after radiotherapy.There were 22(52.3%)adverse events in 42 patients in this study,of which 7(16.7%)were in the effective group and 15(35.7%)in the ineffective group.There was no statistical difference in the comparison of acute liver adverse events between the two groups(p=0.521).Conclusion:1.IMRT has good clinical efficacy in patients with advanced unresectable hepatocellular carcinoma without serious treatment-related adverse reactions.2.The diameter of tumor,concomitant with venous tumor thrombus,combined intervention and combined targeting are the related factors affecting the curative effect of radiotherapy.3.Patients with venous tumor thrombus,tumor diameter and combined targeted therapy are independent prognostic factors of patients with advanced hepatocellular carcinoma.