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Al B. Benson III, MD, FACP, FASCO

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Is IMRT Before Surgery of Benefit in Patients With Centrally Located Liver Cancer?

By: Joshua D. Madera, MS
Posted: Thursday, January 19, 2023

The use of neoadjuvant intensity-modulated radiotherapy (IMRT) before surgical resection of hepatocellular carcinoma with a hepatectomy may be an efficacious and tolerable treatment option for patients with centrally located disease, according to a study published in JAMA Surgery. However, additional investigative efforts are warranted to determine the extent of this approach’s efficacy, suggested Jianxiong Wu, MD, of the Peking University Cancer Hospital and Institute, China, and colleagues.

From 2014 to 2019, a total of 38 patients with centrally located hepatocellular carcinoma were recruited for the nonrandomized, controlled study. All patients had Child-Pugh class A liver function and had not received any previous treatment. They received liver-directed neoadjuvant IMRT over a 5- to 6-week period, and their status was subsequently discussed at a multidisciplinary team meeting to determine the best surgical approach.

The study findings revealed that 34.2% of patients reached a major pathologic response after treatment. From this cohort, 13.2% of patients reached a complete pathologic response. In addition, there was a 94.6%, 75.4%, and 69.1% overall survival rate at 1-, 3-, and 5-year intervals, respectively. A 45.8-month median disease-free survival rate was reported, with patients achieving 70.3%, 54.1%, and 41.0% disease-free survival rates at 1-, 3-, and 5-year intervals.

Moreover, 7.9% of patients experienced grade 3 radiotherapy-related adverse effects. Furthermore, complications from surgical intervention were observed in 34.2% of patients. They included grade 1 to 2 complications (31.6%) and grade 3a complications (2.6%). More severe complications were not observed in any patients, according to the investigators.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.


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