Radiation Therapy, Combined with Chemoembolization, Effective in Some Persons

Radiation Therapy, Combined with Chemoembolization, Appears Effective in Some Persons with Inoperable Liver Cancer

The use of radiation therapy can be effective in prolonging the survival time for some persons with inoperable liver cancer, according to a recent report from researchers in Taiwan. These investigators also noted that the combination of radiation therapy and chemoembolization may offer an added benefit in the treatment of some persons with this disease.

Primary cancer of the liver is characterized by cancer cells that begin to grow in the liver, the largest organ in the human body. These cancer cells can then grow in size and can also spread to the veins or arteries of the liver and/or to other parts of the body (called advanced or metastatic disease). The most common type of primary liver cancer is called hepatocellular carcinoma. Hepatocellular carcinoma often develops in persons whose livers are damaged by other serious conditions, such as hepatitis and/or cirrhosis.

The treatment of hepatocellular carcinoma depends on many factors including the size and stage of the cancer (extent of disease at diagnosis) and the overall health of the patient. When possible, the cancer is completely surgically removed from the liver (called surgical resection), offering a chance for cure. However, when the cancer is too advanced or large to be removed by surgery or the patient is too ill to undergo surgery, effective nonsurgical treatments are needed to control the cancer and prolong survival time. Several options, such as radiation therapy and chemotherapy strategies, may be used for this purpose. One technique that has recently been used to treat inoperable liver cancers, called chemoembolization, involves blocking the main artery that supplies the liver (called the hepatic artery) and injecting chemotherapy drugs between this blockage and the liver. This method of delivery allows the drugs to travel to the cancer cells in the liver, while also blocking much of the blood supply to these cancer cells. This approach is effective because cancer cells in the liver receive much of their blood supply from the hepatic artery, while healthy liver cells also receive blood from what is called the portal vein and can therefore survive blockage of the artery.

Researchers from Taiwan treated 25 persons who had inoperable hepatocellular carcinoma. Twenty-three of these persons also had cirrhosis. All patients underwent radiation therapy to the affected part of the liver; 16 patients also underwent chemoembolization. Overall, the 2-year survival rate was 41% and the average survival time was 19 months. Only 3 persons experienced a progression of the cancer within the liver, and cancer recurrence (return) within the liver was infrequent. Persons having advanced (late-stage) cancer or cancer that involved the portal vein did not respond as well to the therapy. The combination of radiation therapy and chemoembolization appeared to be more effective than radiation therapy alone; however, this could be because the radiation therapy only group had more individuals with advanced disease. The main treatment side effects were radiation-related liver disease and gastrointestinal bleeding.

These researchers concluded that radiation therapy is effective in persons with inoperable hepatocellular carcinoma, as evidenced by the small number of persons who had progression of cancer or a recurrence of cancer in the area exposed to the radiation. The combination of radiation therapy/chemoembolization appears promising, but further study is needed to determine whether it is indeed more effective than radiation therapy alone. Persons who have inoperable hepatocellular carcinoma may wish to talk with their doctor about the risks and benefits of participating in a clinical trial in which radiation therapy/chemoembolization or another promising new treatment regimen is being studied.

(International Journal of Radiation Oncology, Biology and Physics, Vol 47, No 1, pp 435-442, 2000)

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