Impact of pretreatment cholinesterase level on survival of inoperable intrahepatic or hepatic-hilar carcinomas treated with three-dimensional conformal radiotherapy.

PURPOSE: Prognostic factors for inoperable hepatocellular carcinomas (HCC), intrahepatic cholangiocellular carcinomas (IHCC), and hepatic-hilar cholangiocellular carcinomas (HHCC) treated with three-dimensional conformal radiotherapy (3DCRT) were evaluated. MATERIALS AND METHODS: Thirty-five consecutive patients were treated with 3DCRT (HCC, 14; IHCC, 11; HHCC, 10). Doses of 3DCRT ranged from 30-70 Gy (mean, 51.5 Gy). The follow-up time of the 12 living patients was 5-39 (median, 11) months. RESULTS: Two-year overall survival rates of HCC, IHCC, and HHCC were 19%, 26%, and 39%, respectively. On univariate analysis, 3DCRT dose ( or =60 Gy) (p or =60 Gy were 0%, 50%, and 17%, respectively. The difference in survival between patients given 50-54 Gy and > or =60 Gy was not statistically significant (p=0.13). Two-year overall survival rates of patients with higher and lower cholinesterase values were 43% and 0%, respectively. On multivariate analysis, the independent variable most predictive of survival was pre-3DCRT cholinesterase value (p<0.01). CONCLUSION: Pre-3DCRT cholinesterase value was a significant independent prognostic indicator for survival. Benefit of dose escalation above 60 Gy could not be demonstrated.