JAMA sub-journal: Neoadjuvant intensity-modulated radiotherapy combined with surgery is safe and effective in the treatment of central hepatocellular carcinoma

Central hepatocellular carcinoma (HCC) is a specific type of liver cancer that is not well treated with surgery alone, and there is currently no standard adjuvant or neoadjuvant therapy that can improve clinical outcomes
.
It is unclear whether neoadjuvant intensity-modulated radiotherapy (IMRT) combined with surgery is safe
and effective for HCC.

The results of a study from JAMA sub-journal show that IMRT combined with surgery is safe and effective
in the treatment of HCC.

▎Research protocol:

The Phase 2, single-center, single-arm prospective non-randomized controlled trial was conducted
at Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China from December 16, 2014 to January 29, 2019.
The last follow-up visit was on 30 July 2021
.
Patients with central HCC who underwent neoadjuvant IMRT and surgery were included in the analysis
.
The intervention was hepatic resection
followed by neoadjuvant IMRT therapy.
The primary endpoint was 5-year overall survival (OS).

Secondary endpoints were tumor response to IMRT, 5-year disease-free survival (DFS), and treatment-related adverse events
.

▎Key findings:

(1) 38 patients [mean (SD) age, 55.
6 (9.
3) years; 35 males (92.
1%)] completed the designated neoadjuvant IMRT
without interruption.

(2) Preoperative imaging responses to IMRT included partial responses [16 (42.
1%)] and stable disease [22 (57.
9%)].

Thirteen patients (34.
2%) experienced major pathological reactions, of which 5 (13.
2%) had complete pathological reactions
.

(3) The median follow-up time was 45.
8 months, and the median OS was not reached, and the OS rate was 94.
6% at 1 year, 75.
4% at 3 years, and 69.
1%
at 5 years.
The median DFS was 45.
8 months, and the 1-year DFS rate was 70.
3%, 3-year 54.
1%, and 5-year DFS was 41.
0%.

(4) Grade 3 adverse events
related to radiotherapy were observed in 3 patients (7.
9%).
Nineteen surgical complications (34.
2%) occurred in 13 patients, including class I to II complications (31.
6%) in 12 patients and grade IIIa complications (2.
6%)
in 1 patient.
No surgical complications of grade IIIb or higher were observed
.

▎Outlook:

In summary, neoadjuvant IMRT combined with surgery is effective and well
tolerated in patients with central HCC.
These data may inform future randomized clinical trials of this new treatment strategy
.