Simultaneous multitarget radiotherapy using helical tomotherapy and its combination with sorafenib for pulmonary metastases from hepatocellular carcinoma

Abstract

// Taiwei Sun 1,* , Jian He 1,* , Shumin Zhang 1 , Jing Sun 1 , Mengsu Zeng 2 and Zhaochong Zeng 1 1 Department of Radiation Oncology, Zhong Shan Hospital, Fudan University, Shanghai, P.R. China 2 Department of Radiology, Zhong Shan Hospital, Fudan University, Shanghai, P.R. China * These authors have contributed equally to this work Correspondence to: Zhaochong Zeng, email: // Keywords : hepatocellular carcinoma; pulmonary metastases; prognosis; radiotherapy; helical tomotherapy Received : December 20, 2015 Accepted : May 05, 2016 Published : May 14, 2016 Abstract We evaluated radiotherapy using helical tomotherapy (HT) combined with sorafenib for treatment of pulmonary metastases from hepatocellular carcinoma (HCC). We also analyzed potential prognostic factors and further validated the combination treatment. The objective response rate in the total cohort of 45 patients treated with HT (with or without sorafenib) was 66.7% (complete response, n = 1; partial response, n = 29), with no adverse events > grade 2 in severity. Median progression-free survival (PFS) and overall survival (OS) were 7.50 ± 0.53 and 26.40 ± 2.66 months, respectively. The addition of sorafenib was associated with increased PFS (11.80 ± 1.55 vs 5.80 ± 0.52 months, p = 0.006) and increased OS (29.60 ± 5.23 vs 21.90 ± 5.17 months, p = 0.007). After multivariate adjustment, the risk of disease progression associated with combination treatment was significantly lower ( p = 0.022) compared with HT only, and survival was significantly longer ( p = 0.014). Further validation confirmed the benefit of combination treatment. Prognostic factors were number of pulmonary metastases for PFS (19.00 ± 7.15 months for ≤3 lesions vs 5.80 ± 0.26 months for >3 lesions, p < 0.001) and intrahepatic tumor status for OS (28.50 ± 2.76 months for well-controlled tumors vs 15.60 ± 6.38 months for uncontrolled tumors, p = 0.011). In conclusion, radiotherapy with HT for pulmonary metastases is feasible without major complications, and its combination with sorafenib may be a promising approach in a subgroup of patients.