Radiation therapy for the locoregional lymph node metastases from hepatocellular carcinoma, phase I clinical trial

Background/Aims: The patients with lymph node metastasis from hepatocellular carcinoma may survive only a few months. These patients are not suitable for transcatheter arterial chemoembolization, percutaneous ethanol injection and surgical resection. External beam radiation therapy (EBRT) could provide a useful treatment, but only 4 hepatocellular carcinoma cases with abdominal lymph nodes involvement were treated with EBRT in the two reports over the last 10 years. In this paper, we report 29 hepatocellular carcinoma patients with abdominal lymph node metastasis who received EBRT over a period of 5 years. Methodology: Of 29 patients, 20 were pathologically confirmed to have hepatocellular carcinoma and 9 patients were clinically diagnosed to have hepatocelular carcinoma. All of the patients had proven abdominal lymph node metastasis by enhanced abdominal computer tomography scan due to clinical follow-up or abdominal symptoms. EBRT was not the initial treatment in all. The patients received locoregional lymph nodes irradiation. The tumor dose ranged from 30 to 60 Grays (Gy) in daily 2.0-Gy fractions (Fx), 5 times a week. Results: It is of interest to note that an objective regression (complete response and partial response) rate was 100%. The clinical symptoms were relieved. The median survival time was 8 (4-28) months. The overall 1-year and 2-year survival rates were 43.5% and 10.5%, respectively. The median survival time consistently decreased as the lymph node involvement increase follows the natural flow of lymph. Conclusions: Lymph node metastasis from hepatocellular carcinoma is sensitive to EBRT, although EBRT is palliative in intent, it is useful in the treatment with 50Gy/25Fx for those patients.