Radiation therapy for lymph node metastases from hepatocellular carcinoma

Background/Aims: Recent improvements in the prognosis of patients with hepatocellular carcinoma (HCC) render the discovery and treatment of lymph node (LN) metastasis increasingly important. We retrospectively evaluated the treatment outcomes of radiation therapy (RT) for LN metastases from HCC. Methodology: Twenty-three patients with LN metastases from HCC underwent RT. A daily dose of 1.8 - 4 Gy was administered to deliver a total dose of 28 - 56 Gy, which was a biologic effective dose (BED) of 36 - 67.2 Gy 10 (median 58.5 Gy 10 ) with an α/β ratio of 10. We evaluated predictive factors for local control and survival. Results: A complete response and partial response were recorded for 5 and 14 patients, respectively. The response rate was 83%; it was significantly higher in patients who had received >58 Gy 10 rather than <58 Gy 10 (p = 0.014). The median survival time was 19 months. Univariate analysis revealed that the Child-Pugh's classification, status of the liver tumor, and LN metastasis site were significant factors for survival. Multivariate analysis showed that the status of the liver tumor was the only independent predictor of survival. Conclusions: RT is effective for the local control of LN metastases from HCC without a confirmed survival effect. RT doses greater than 58 Gy 10 are required for a better local response.