الفهرس 
Introduction
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Introduction: Hepatocellular carcinoma is the most severe complication of chronic liver disease. The overall incidence remains alarmingly high in the developing world especially in Egypt. Combined treatment of TACE with 3D-CRT has some advantages. Tumor shrinkage after TACE makes the radiation field smaller, lipiodol uptake of the tumor aids in delineating the target a radiosensitizing effect.
Aim of work is to evaluate the efficacy and toxicity of combined therapy of three-dimensional conformal radiotherapy (3DCRT) and trans-arterial Chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC).
METHODS: Between August 2009 and August 2011, 15 patients with locally advanced unresectable HCC were enrolled prospectively in this study. TACE was performed first by using mixture of 50mgAdriamycin, 750mg 5-Fluorouracil, 50 mg cisplatin, and lipiodol with a median of two courses, followed by 3DCRT (30-50 GY, 1.8GY/day, 5days/week) after 8-10 weeks. Tumor response was evaluated by the European Association for the Study of Liver disease (EASL) recommendation to account tumor necrosis recognized by non enhanced areas on serial computed tomography scans and toxicity was evaluated by the Common Terminology Criteria for Adverse Events Version 4 (CTCAE 4).
RESULTS: An objective response was achieved in 5 patients (33.4%), with a complete response in 2 patients (13.3%) and partial response in 3 patients (20.1%). The overall survival rates were 60%, 20%, at 1 year, and 2 year respectively, with mean survival time was 18 months. The progression-free rate at the end of study was 86.7%, with median progression free survival (PFS) 18 months. T stage, child-Pugh grade, ECOG performance status, PVT, number of TACE session and radiotherapy dose were identified as independent predictors for survival by univariate analysis. All are still significant by multivariate analysis except radiotherapy dose. Regarding acute toxicities, most toxicity were mild to moderate, transient and most patients recovered within 1-2week. Radiation induced liver disease (RILD) was developed in13.3%.
CONCLUSION: The combined modality is tolerable, effective therapeutic strategy in carefully selected patients and need further trials to confirm the efficacy of this combined therapy.