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Reuters Health Information (2005-12-05): Radiation therapy improves outcome of unresectable hepatic cancer

Drug & Device Development

Radiation therapy improves outcome of unresectable hepatic cancer

Last Updated: 2005-12-05 11:10:47 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Adding high-dose conformal radiation therapy (RT) to intra-arterial floxuridine improves outcomes in patients with unresectable intrahepatic malignancies, according to a report in the December 1st Journal of Clinical Oncology.

"I would like physicians to be aware of the potential usefulness of high-dose focal radiotherapy for those patients who do not have surgical options," Dr. Edgar Ben-Josef from University of Michigan, Ann Arbor, told Reuters Health. "There is currently little awareness of radiotherapy as an option for these patients."

In a phase II trial, Dr. Ben-Josef and colleagues investigated the outcomes of 128 patients with unresectable intrahepatic primary hepatic biliary cancers or liver metastases from colorectal cancer treated concurrently with three-dimensional conformal high-dose radiation therapy and hepatic arterial floxuridine.

Actuarial 3-year overall survival was 17%, the authors report, and the median survival was 15.8 months after the start of radiotherapy.

Median survival was highest for metastatic colorectal cancer (17.2 months), intermediate for hepatocellular carcinoma (15.2 months), and lowest for cholangiocarcinoma (13.3 months).

All of these survival times were longer than the 8-to-9 months median survival expected for these diseases, the results indicate.

Radiotherapy dose was a significant predictor of survival, the researchers note, with doses of at least 75 Gy bringing an overall survival nearly twice as high (23.9 months) as that seen with lower doses (14.9 months).

Nearly half the patients with primary hepatic cancers were free from extrahepatic progression at 3 years, the report indicates, compared with only 15.1% of the patients with metastatic colorectal cancer.

Thirty percent of the patients developed grade 1/2 toxicity, 30% developed grade 3/4 toxicity, and there was one treatment-related death.

"In smaller lesions, this could probably work just as well as other nonablative methods, and patients who are not candidates for nonsurgical ablation could still benefit from RT," Dr. Ben-Josef said.

"I'd like to emphasize that this is not an alternative to chemotherapy in those who are candidates for chemotherapy." Dr. Ben-Josef explained. "There is no reason why patients could not have both, and we believe that these two forms of therapy are complementary in metastatic colorectal cancer: aggressive systemic therapy plus aggressive local therapy."

"We are about to initiate a phase II trial of intensity-modulated radiotherapy with concurrent floxuridine," Dr. Ben-Josef added. "Our preliminary work has suggested that we can deliver an even higher dose than we had in the reported trial with the same or reduced expected level of toxicity."

J Clin Oncol 2005;23:8739-8747.

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