Volumetric modulated arc therapy versus supportive care in patients with inoperable hepatocellular carcinoma and not amenable to local ablative therapies / Sarah Ayman Hussein Nassar ; Supervised Iman Abdelhady Hassan , Tamer Ibrahim Elnahas , Ashraf Mounir Maurice

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Oncology (Radiation)

Background : To assess the role of volumetric modulated arc therapy (VMAT) in management of advanced HCC patients and compare survival outcome with Best Supportive Care (BSC) as well as the response rate and toxicity of VMAT. Methods :Fifty patients were enrolled in the study and divided into two groups, arm (A) included 25 patients received radiation therapy 50.4 Gy in 28 fractions and arm (B) received palliative care in the form of pain management, nutritional and liver supportMedian age of the whole group is 56.5 years, the majority are males who are HCV positive carriers > 90%. More than 50% are child Pugh (B), the rest are (A).according to BCLC staging 48% of the patients are stage C. Patients in both arms are closely similar regarding baseline clinical and pathological parameters.Results: Median PFS in arm A was 6.9 months versus 5.9 months for arm B and this was statistically significant with P.value =0.01,but median OS was equal in both arms (10 monthes in both) with P.value = 0.5.The overall response rate is 44% ( 1 patient had CR and 10 patients had PR). Tumor response and performance status are the 2 most important prognostic factors that shows statistical significant difference with overall survival in arm (A) , where patients with CR or PR had longer OS survival (12 months) compared to those with SD (10 months) or PD (4 months) with P-value 0.001.Also patients with PS 1 had longer survival (10 months) compared to those with PS 2 (6 months) with P-value 0.01.The most common toxicity with radiation is RILD (28%) and the most important significant factor associated With RILD is the PTV volume (P-value is 0.02).Conclusion: Radiotherapy with VMAT provides PFS advantage over BSC and achieved a good response rate in patients with advanced hepatocellular carcinoma and patients who had a good response lived longer than patients who had poor response

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