Hyperfractionated Three-dimensional Conformal Radiotherapy for Small Hepatocellular Carcinoma: A Pilot Study

The purpose of this study is to evaluate the therapeutic results of small hepatocellular carcinoma (HCC) treated with hyperfractionated three-dimensional conformal radiotherapy (3-D conformal RT). This retrospective study was to review 39 small HCC (tumor ≤ 5 cm in size) patients who had been treated with hyperfractionated 3-D conformal RT from October 1999 to December 2000. The mean age was 59.79 ± 10.45 years old (range 35-80 years old). Patients had the mean follow-up period of 511.67 ± 104.81 days (range 307-812 days). Hyperfractionated 3-D conformal RT was delivered using 6 or 10 MV photons at 1.5 Gy per fraction, twice a day on 5 days of the week for a total dose of 45-75 Gy. The mean treatment volume was 137.22 ± 76.40 ml (ranged 26.93-334.06 ml). The cumulative survival rates were 100.0% for 180 days, 97.44% for 360 days and 62.64% for 720 days, respectively. The overall median survival time was 495 days. Acute radiation toxicity included 10 patients (25.6%) leukopenia, 9 patients (23.1%) had elevation in liver function tests, 3 patients (7.7%) had fever and 13 patients (33.3%) complained GI toxicity. Late complications were occurred in 3 patients (2 RT enteritis, 1 UGI bleeding). Our experience concludes that hyperfractionated 3-D conformal RT may be a safe, effective treatment modality in small HCC patients with preserved liver function even if they have already been treated with other therapies. The preliminary data shows quite promising and is valuable to study the potential role of 3-D conformal RT in strengthening the therapeutic efficacy when combined with other therapy.