Background: To assess the role of volumetric modulated arc therapy (VMAT) in management of advanced Hepatocellular carcinoma(HCC) patients and compare survival outcome with Best Supportive Care (BSC) as well as the response rate and toxicity of VMAT.
Method: Fifty patients were enrolled in the study and divided into two groups, arm (A) which is radiotherapy included 25 patients received radiation therapy 50.4Gy in 28 fractions and arm (B) which is Best Supportive Care where patients received palliative care in the form of pain management, nutritional and liver support. Median age of the whole group is 56.5 years, the majority are males who are HCV positive carriers > 90%. More than 50% are child Pugh (B), the rest are (A).according to BCLC staging 48% of the patients are stage C. Patients in both arms are closely similar regarding baseline clinical and pathological parameters.
Results: Median progression free survival (PFS) in arm A was 6.9 months versus 5.9 months for arm B and this was statistically significant with P-value = 0.01, but median Overall Survival (OS) was equal in both arms (10 months in both) with P = 0.5.The overall response rate (ORR) is 44% (1 patient had Complete Response (CR) and 10 patients had Partial Response (PR). Tumor response and performance status(PS) are the 2 most important prognostic factors that shows statistical significant difference with overall survival in arm (A) , where patients with CR or PR had longer OS survival (12 months) compared to those with Stationary Disease(SD) (10 months) or Progressive Disease(PD) (4 months) with P-value 0.001.Also patients with PS 1 had longer survival (10 months) compared to those with PS 2 (6 months) with P-value 0.01.The most common toxicity with radiation was radiation induced liver disease(RILD) (28%) and the most important factor associated With the occurrence of RILD was the planning target volume(PTV) (P=0.02).
Conclusion: Radiotherapy with VMAT provides PFS advantage over BSC and achieved a good response rate in patients with advanced Hepatocellular carcinoma and patients who had a good response lived longer than patients who had poor response.
Key words: Hepatocellular carcinoma, radiotherapy, Rapid Arc, VMAT, Best Supportive Care