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Palliative Radiotherapy

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Radiotherapy of Liver Cancer

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Abstract

Palliative radiotherapy (RT) is a relative term, which refers to the use of RT in situations when it is impossible to completely eliminate all visible lesions. It contrasts with radical RT, in which the goal is complete elimination of visible tumors. One or both of the following conditions are regarded as palliative RT: (1) the radiation dose fails to achieve radical goals unless combined with other radical treatments, such as surgical resection; and (2) visible lesions exist beyond the radiation fields. Since radical goals cannot be achieved, palliative RT aims to relieve cancer symptoms and slightly prolong survival.

A considerable proportion of patients with hepatocellular carcinoma (HCC) have intrahepatic lesions that may be converted to sequential surgical resection after the combination of RT and transarterial chemoembolization (TACE). We classify this type of RT as consolidation RT, not palliative RT. This chapter discusses the use of RT for portal vein (PV)/inferior vena cava (IVC) tumor thrombi, as well as extrahepatic metastatic lesions, including lymph node (LN), bone, pulmonary, and adrenal metastases.

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References

  1. Pirisi M, Avellini C, Fabris C, et al. Portal vein thrombosis in hepatocellular carcinoma: age and sex distribution in an autopsy study. J Cancer Res Clin Oncol. 1998;124:397–400.

    Article  CAS  PubMed  Google Scholar 

  2. Stuart KE, Anand AJ, Jenkins RL. Hepatocellular carcinoma in the United States. Prognostic feature, treatment outcome, and survival. Cancer. 1996;77:2217–22.

    Article  CAS  PubMed  Google Scholar 

  3. Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western Center. Ann Surg. 1999;229:790–800.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Rabe C, Pilz T, Klostermann C, et al. Clinical characteristics and outcome of a cohort of 101 patients with hepatocellular carcinoma. World J Gastroenterol. 2001;7:208–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ando E, Yamashita F, Tanaka M, Tanikawa K. A novel chemotherapy for advanced hepatocellular carcinoma with tumor thrombosis of the main trunk of the portal vein. Cancer. 1997;79:1890–6.

    Article  CAS  PubMed  Google Scholar 

  6. The Cancer of the Liver Italian Program Investigators. A new prognostic system for hepatocellualr carcinoma: a retrospective study of 435 patients. Hepatology. 1998;28:751–5.

    Article  Google Scholar 

  7. Wei X, Jiang Y, Zhang X, et al. Neoadjuvant three-dimensional conformal radiotherapy for resectable hepatocellular carcinoma with portal vein tumor thrombus: a randomized, open-label, multicenter controlled study. J Clin Oncol. 2019;37(24):2141–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Abou-Alfa GK, Shi Q, Knox JJ, et al. Assessment of treatment with sorafenib plus doxorubicin vs sorafenib alone in patients with advanced hepatocellular carcinoma: phase 3 CALGB 80802 randomized clinical trial. JAMA Oncol. 2019;5(11):1582–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. He M, Li Q, Zou R, et al. Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion: a randomized clinical trial. JAMA Oncol. 2019;5(7):953–60.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yoon SM, Ryoo BY, Lee SJ, Kim JH, Shin JH, An JH, Lee HC, Lim YS. Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion: a randomized clinical trial. JAMA Oncol. 2018;4(5):661–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kodama K, Kawaoka T, Aikata H, et al. Comparison of outcome of hepatic arterial infusion chemotherapy combined with radiotherapy and sorafenib for advanced hepatocellular carcinoma patients with major portal vein tumor thrombosis. Oncology. 2018;94(4):215–22.

    Article  CAS  PubMed  Google Scholar 

  12. Hou JZ, Zeng ZC, Wang BL, Yang P, Zhang JY, Mo HF. High dose radiotherapy with image-guided hypo-IMRT for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombi is more feasible and efficacious than conventional 3D-CRT. Jpn J Clin Oncol. 2016;46(4):357–62.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wang K, Guo WX, Chen MS, et al. Multimodality treatment for hepatocellular carcinoma with portal vein tumor thrombus: a large-scale, multicenter, propensity mathching score analysis. Medicine (Baltimore). 2016;95(11):e3015.

    Article  Google Scholar 

  14. Kim GA, Shim JH, Yoon SM, et al. Comparison of chemoembolization with and without radiation therapy and sorafenib for advanced hepatocellular carcinoma with portal vein tumor thrombosis: a propensity score analysis. J Vasc Interv Radiol. 2015;26(3):320–9.e6.

    Article  PubMed  Google Scholar 

  15. Onishi H, Nouso K, Nakamura S, et al. Efficacy of hepatic arterial infusion chemotherapy in combination with irradiation for advanced hepatocellular carcinoma with portal vein invasion. Hepatol Int. 2015;9(1):105–12.

    Article  PubMed  Google Scholar 

  16. Lu DH, Fei ZL, Zhou JP, et al. A comparison between three-dimensional conformal radiotherapy combined with interventional treatment and interventional treatment alone for hepatocellular carcinoma with portal vein tumour thrombosis. J Med Imaging Radiat Oncol. 2015;59(1):109–14.

    Article  PubMed  Google Scholar 

  17. Nakazawa T, Hidaka H, Shibuya A, et al. Overall survival in response to sorafenib versus radiotherapy in unresectable hepatocellular carcinoma with major portal vein tumor thrombosis: propensity score analysis. BMC Gastroenterol. 2014;14:84.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Tang QH, Li AJ, Yang GM, et al. Surgical resection versus conformal radiotherapy combined with TACE for resectable hepatocellular carcinoma with portal vein tumor thrombus: a comparative study. World J Surg. 2013;37(6):1362–70.

    Article  PubMed  Google Scholar 

  19. Chuma M, Taguchi H, Yamamoto Y, et al. Efficacy of therapy for advanced hepatocellular carcinoma: intra-arterial 5-fluorouracil and subcutaneous interferon with image-guided radiation. J Gastroenterol Hepatol. 2011;26(7):1123–32.

    Article  PubMed  Google Scholar 

  20. Chung YH, Song IIH, Song BC, et al. Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-α for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis. Cancer. 2000;88:1986–91.

    Article  CAS  PubMed  Google Scholar 

  21. Ando E, Tanaka M, Yamashita F, et al. Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: analysis of 48 cases. Cancer. 2002;95:588–95.

    Article  PubMed  Google Scholar 

  22. Yen FS, Wu JC, Kuo BI, et al. Transcatheter arterial embolization for hepatocellular carcinoma with portal vein thrombosis. J Gastroenterol Hepatol. 1995;10:237–40.

    Article  CAS  PubMed  Google Scholar 

  23. Minagawa M, Makuuchi M, Takayama TK, et al. Selection criteria for hepatectomy in patients with hepatocellular carcinoma and portal vein tumor thrombus. Ann Surg. 2001;233:379–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Cheng SH, Lin YM, Chuang VP, et al. A pilot study of three dimensional conformal radiotherapy in unresectable hepatocellular carcinoma. J Gastroenterol Hepatol. 1999;14:1025–33.

    Article  CAS  PubMed  Google Scholar 

  25. Ishikura S, Ogino T, Furuse J, et al. Radiotherapy after transcatheter arterial chemoembolization for patients with hepatocellular carcinoma and portal vein tumor thrombus. Am J Clin Oncol. 2002;25:189–93.

    Article  PubMed  Google Scholar 

  26. Zeng ZC, Fan J, Zhou J, et al. A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus. Int J Radiation Oncology Boil Phys. 2005;61:432–43.

    Article  Google Scholar 

  27. Nakazawa T, Adachi S, Kitano M, et al. Potential prognostic benefits of radiotherapy as an initial treatment for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels. Oncology. 2007;73:90–7.

    Article  PubMed  Google Scholar 

  28. Koo JE, Kim JH, Lim YS, et al. Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus. Int J Radiat Oncol Biol Phys. 2010;78:180–7.

    Article  PubMed  Google Scholar 

  29. Chen LW, Chien RN, Fang KM, et al. Elucidating therapeutic effects on patients with hepatocellular carcinoma and main portal vein thrombosis. Hepato-Gastroenterology. 2010;57(98):228–31.

    CAS  PubMed  Google Scholar 

  30. Kim DY, Park W, Lim DH, et al. Three-dimensional conformal radiotherapy for portal vein thrombosis of hepatocellular carcinoma. Cancer. 2005;103:2419–26.

    Article  PubMed  Google Scholar 

  31. Nakagawa K, Yamashita H, Shiraishi K, et al. Radiation therapy for portal venous invasion by hepatocellular carcinoma. World J Gastroenterol. 2005;11:7237–41.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lin CS, Jen YM, Chiu SY, et al. Treatment of portal vein tumor thrombosis of hepatoma patients with either stereotactic radiotherapy or three-dimensional conformal radiotherapy. Jpn J Clin Oncol. 2006;36:212–7.

    Article  PubMed  Google Scholar 

  33. Toya R, Murakami R, Baba Y, et al. Conformal radiation therapy for portal vein tumor thrombosis of hepatocellular carcinoma. Radiother Oncol. 2007;84:266–71.

    Article  PubMed  Google Scholar 

  34. Yoon SM, Lim YS, Won HJ, et al. Radiotherapy plus transarterial chemoembolization for hepatocellular carcinoma invading the portal vein: long-term patient outcomes. Int J Radiat Oncol Biol Phys. 2012;82:2004–11.

    Article  PubMed  Google Scholar 

  35. Hou JZ, Zeng ZC, Zhang JY, et al. Influence of tumor thrombus location on the outcome of external-beam radiation therapy in advanced hepatocellular carcinoma with macrovascular invasion. Int J Radiat Oncol Biol Phys. 2012;84:362–8.

    Article  PubMed  Google Scholar 

  36. Rim CH, Yang DS, Park YJ, et al. Effectiveness of high-dose three-dimensional conformal radiotherapy in hepatocellular carcinoma with portal vein thrombosis. Jpn J Clin Oncol. 2012;42:721–9.

    Article  PubMed  Google Scholar 

  37. Zhang XB, Wang JH, Yan ZP, et al. Hepatocellular carcinoma with main portal vein tumor thrombus. Treatment with 3-D conformal radiotherapy after portal vein stenting and transarterial chemoembolization. Cancer. 2009;115:1245–52.

    Article  PubMed  Google Scholar 

  38. Han KH, Seong J, Kim JK, et al. Pilot clinical trial of localized concurrent chemoradiation therapy for locally advanced hepatocellular carcinoma with portal vein thrombosis. Cancer. 2008;113:995–1003.

    Article  CAS  PubMed  Google Scholar 

  39. Katamura Y, Aikata H, Takaki S, et al. Intra-arterial 5-Fu/interferon combination therapy for advanced hepatocellular carcinoma with or without 3-dimensional conformal radiotherapy for portal vein tumor thrombosis. J Gastroenterol. 2009;44:492–502.

    Article  CAS  PubMed  Google Scholar 

  40. Kim BK, Kim DY, Byun HK, et al. Efficacy and safety of liver-directed concurrent chemoradiotherapy and sequential sorafenib for advanced hepatocellular carcinoma: a prospective phase 2 trial. Int J Radiat Oncol Biol Phys. 2020;107(1):106–15.

    Article  PubMed  Google Scholar 

  41. Kamiyama T, Nakanishi K, Yokoo H, et al. Efficacy of preoperative radiotherapy to portal vein tumor thrombus in the main trunk or first branch in patients with hepatocellular carcinoma. Int J Clin Oncol. 2007;12:363–8.

    Article  PubMed  Google Scholar 

  42. Kim J, Lee I, Kim J, et al. Clinical features of hepatocellular carcinoma patients undergoing resection after concurrent chemoradiation therapy. Int J Radiat Oncol Biol Phys. 2012;84:S336–7.

    Article  Google Scholar 

  43. Shirabe K, Shimada M, Tsujita E, et al. Thrombectomy before hepatic resection for hepatocellular carcinoma with a tumor thrombus extending to the inferior vena cava. Int Surg. 2001;86:141–3.

    CAS  PubMed  Google Scholar 

  44. Yogita S, Tashiro S, Harada M, et al. Hepatocellular carcinoma with extension into the right atrium: report of a successful liver resection by hepatic vascular exclusion using cardiopulmonary bypass. J Med Investig. 2000;47:155–60.

    CAS  Google Scholar 

  45. Wu CC, Hseih S, Ho WM, et al. Surgical treatment for recurrent hepatocellular carcinoma with tumor thrombi in right atrium: using cardiopulmonary bypass and deep hypothermic circulatory arrest. J Surg Oncol. 2000;74:227–31.

    Article  CAS  PubMed  Google Scholar 

  46. Rim CH, Jeong BK, Kim TH, Hee Kim J, Kang HC, Seong J. Effectiveness and feasibility of external beam radiotherapy for hepatocellular carcinoma with inferior vena cava and/or right atrium involvement: a multicenter trial in Korea (KROG 17-10). Int J Radiat Biol. 2020;96(6):759–66.

    Article  CAS  PubMed  Google Scholar 

  47. Murakami E, Aikata H, Miyaki D, et al. Hepatic arterial infusion chemotherapy using 5-fluorouracil and systemic interferon-α for advanced hepatocellular carcinoma in combination with or without three-dimensional conformal radiotherapy to venous tumor thrombosis in hepatic vein or inferior vena cava. Hepatol Res. 2012;42:442–53.

    Article  CAS  PubMed  Google Scholar 

  48. Zeng ZC, Fan J, Tang ZY, et al. Prognostic factors for hepatocellular carcinoma with macroscopic portal vein or inferior vena cava tumor thrombi receiving radiotherapy. Cancer Sci. 2008;99:2510–7.

    Article  CAS  PubMed  Google Scholar 

  49. Kim JY, Yoo EJ, Jang JW, Kwon JH, Kim KJ, Kay CS. Hypofractionated radiotherapy using helical tomotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis. Radiat Oncol. 2013;8:15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Sun HC, Zhuang PY, Qin LX, et al. Incidence and prognostic values of lymph node metastasis in operable hepatocellular carcinoma and evaluation of routine complete lymphadenectomy. J Surg Oncol. 2007;96:37–45.

    Article  PubMed  Google Scholar 

  51. Kobayashi S, Takahashi S, Kato Y, et al. Surgical treatment of lymph node metastases from hepatocellular carcinoma. J Hepatobiliary Pancreat Sci. 2011;18:559–66.

    Article  PubMed  Google Scholar 

  52. Watanabe J, Nakashima O, Kojiro M. Clinicopathologic study on lymph node metastasis of hepatocellular carcinoma: a retrospective study of 660 consecutive autopsy cases. Jpn J Clin Oncol. 1994;24:37–41.

    CAS  PubMed  Google Scholar 

  53. Yuki K, Hirohashi S, Sakamoto M, et al. Growth and spread of hepatocellular carcinoma: a review of 240 consecutive autopsy cases. Cancer. 1990;66:2174–9.

    Article  CAS  PubMed  Google Scholar 

  54. Zeng ZC, Tang ZY, et al. Consideration of the role of radiotherapy for lymph node metastases in patients with HCC-A retrospective analysis for prognostic factors from 125 patients. Int J Radiation Oncology Boil Phys. 2005;63:1067–76.

    Article  Google Scholar 

  55. Uenishi T, Hirohashi K, Shuto T, et al. The clinical significance of lymph node metastases in patients undergoing surgery for hepatocellular carcinoma. Surg Today. 2000;30:892–5.

    Article  CAS  PubMed  Google Scholar 

  56. Prat F, Chapat O, Ducot B, et al. A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc. 1998;47:1–7.

    Article  CAS  PubMed  Google Scholar 

  57. Cheng AL, Guan Z, Chen Z, et al. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma according to baseline status: subset analyses of the phase III Sorafenib Asia-Pacific trial. Eur J Cancer. 2012;48(10):1452–65.

    Article  CAS  PubMed  Google Scholar 

  58. Chen SC, Lian SL, Chuang WL, et al. Radiotherapy in the treatment of hepatocellular carcinoma and its metastases. Cancer Chemother Pharmacol. 1992;31(suppl):103–5.

    Article  Google Scholar 

  59. Omuraya M, Beppu T, Ishiko T, et al. Lymph node excision with laparotomy and chemo-radiation therapy for a hepatocellular carcinoma patient with multiple lymph node metastases. Gan To Kagaku Tyoho. 2001;28:1699–703.

    CAS  Google Scholar 

  60. Park YJ, Lim DH, Paik SW, et al. Radiation therapy for abdominal lymph node metastasis from hepatocellular carcinoma. J Gastroenterol. 2006;41:1099–106.

    Article  PubMed  Google Scholar 

  61. Yamashita H, Nakagawa K, Shiraishi K, et al. Radiotherapy for lymph node metastases in patients with hepatocellular carcinoma: retrospective study. J Gastroenterol Hepatol. 2007;22:523–7.

    Article  PubMed  Google Scholar 

  62. Toya R, Murakami R, Yasunaga T, et al. Radiation therapy for lymph node metastases from hepatocellular carcinoma. Hepato-Gastroenterology. 2009;56:476–80.

    PubMed  Google Scholar 

  63. Kim K, Chie EK, Kim W, et al. Absence of symptom and intact liver function are positive prognosticators for patients undergoing radiotherapy for lymph node metastasis from hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2010;78:729–34.

    Article  PubMed  Google Scholar 

  64. Chen YX, Zeng ZC, Fan J, et al. Defining prognostic factors of survival after external beam radiotherapy treatment of hepatocellular carcinoma with lymph node metastases. Clin Transl Oncol. 2013;15(9):732–40.

    Article  CAS  PubMed  Google Scholar 

  65. Zhang HG, Chen YX, Hu Y, et al. Image-guided intensity-modulated radiotherapy improves short-term survival for abdominal lymph node metastases from hepatocellular carcinoma. Ann Palliat Med. 2019;8(5):717–27.

    Article  PubMed  Google Scholar 

  66. Marsh JW, Dvorchik I, Bonham CA, et al. Is the pathologic TNM staging system for patients with hepatoma predictive of outcome? Cancer. 2000;88:538–43.

    Article  CAS  PubMed  Google Scholar 

  67. Uchino K, Tateishi R, Shiina S, et al. Hepatocellular carcinoma with extrahepatic metastasis: clinical features and prognostic factors. Cancer. 2011;117:4475–83.

    Article  PubMed  Google Scholar 

  68. Ho CL, Chen S, Cheng TK, Leung YL. PET/CT characteristics of isolated bone metastases in hepatocellular carcinoma. Radiology. 2011;258:515–23.

    Article  PubMed  Google Scholar 

  69. He J, Zeng ZC, Tang ZY, et al. Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma receiving external-beam radiotherapy. Cancer. 2009;115:2710–20.

    Article  PubMed  Google Scholar 

  70. Cho HS, Oh JH, Han I, Kim HS. Survival of patients with skeletal metastases from hepatocellular carcinoma after surgical management. J Bone Joint Surg Br. 2009;91:1505–12.

    Article  CAS  PubMed  Google Scholar 

  71. Kashima M, Yamakado K, Takaki H, et al. Radiofrequency ablation for the treatment of bone metastases from hepatocellular carcinoma. AJR Am J Roentgenol. 2010;194:536–41.

    Article  PubMed  Google Scholar 

  72. Koike Y, Takizawa K, Ogawa Y, et al. Transcatheter arterial chemoembolization (TACE) or embolization (TAE) for symptomatic bone metastases as a palliative treatment. Cardiovasc Intervent Radiol. 2011;34(4):793–801.

    Article  PubMed  Google Scholar 

  73. Uemura A, Fujimoto H, Yasuda S, et al. Transcatheter arterial embolization for bone metastases from hepatocellular carcinoma. Eur Radiol. 2001;11:1457–62.

    Article  CAS  PubMed  Google Scholar 

  74. Katamura Y, Aikata H, Hashimoto Y, et al. Zoledronic acid delays disease progression of bone metastases from hepatocellular carcinoma. Hepatol Res. 2010;40:1195–203.

    Article  CAS  PubMed  Google Scholar 

  75. Montella L, Addeo R, Palmieri G, et al. Zoledronic acid in the treatment of bone metastases by hepatocellular carcinoma: a case series. Cancer Chemother Pharmacol. 2010;65:1137–43.

    Article  CAS  PubMed  Google Scholar 

  76. Suzawa N, Yamakado K, Takaki H, et al. Complete regression of multiple painful bone metastases from hepatocellular carcinoma after administration of strontium-89 chloride. Ann Nucl Med. 2010;24:617–20.

    Article  PubMed  Google Scholar 

  77. Kaizu T, Karasawa K, Tanaka Y, et al. Radiotherapy for osseous metastases from hepatocellular carcinoma: a retrospective study of 57 patients. Am J Gastroenterol. 1998;93:2167–71.

    Article  CAS  PubMed  Google Scholar 

  78. Seong J, Koom WS, Park HC. Radiotherapy for painful bone metastases from hepatocellular carcinoma. Liver Int. 2005;25:261–5.

    Article  PubMed  Google Scholar 

  79. Nakamura N, Igaki H, Yamashita H, et al. A retrospective study of radiotherapy for spinal bone metastases from hepatocellular carcinoma (HCC). Jpn J Clin Oncol. 2007;37:38–43.

    Article  PubMed  Google Scholar 

  80. He J, Zeng ZC, Fan J, et al. Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma after liver transplantation. BMC Cancer. 2011;11:492.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Kneuertz PJ, Cosgrove DP, Cameron AM, et al. Multidisciplinary management of recurrent hepatocellular carcinoma following liver transplantation. J Gastrointest Surg. 2012;16:874–81.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Tung WC, Huang YJ, Leung SW, et al. Incidence of needle tract seeding and responses of soft tissue metastasis by hepatocellular carcinoma postradiotherapy. Liver Int. 2007;27:192–200.

    Article  PubMed  Google Scholar 

  83. Szpakowski JL, Drasin TE, Lyon LL. Rate of seeding with biopsies and ablations of hepatocellular carcinoma: a retrospective cohort study. Hepatol Commun. 2017;1(9):841–51.

    Article  PubMed  PubMed Central  Google Scholar 

  84. He J, Shi S, Ye L, Ma G, Pan X, Huang Y, Zeng Z. A randomized trial of conventional fraction versus hypofraction radiotherapy for bone metastases from hepatocellular carcinoma. J Cancer. 2019;10(17):4031–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Kim SU, Kim DY, Park JY, et al. Hepatocellular carcinoma presenting with bone metastasis: clinical characteristics and prognostic factors. J Cancer Res Clin Oncol. 2008;134:1377–84.

    Article  PubMed  Google Scholar 

  86. Katyal S, Oliver JH III, Peterson MS, Ferris JV, Carr BS, Baron RL. Extrahepatic metastases of hepatocellular carcinoma. Radiology. 2000;216:698–703.

    Article  CAS  PubMed  Google Scholar 

  87. Nakashima T, Okuda K, Kojiro M, Jimi A, Yamaguchi R, Sakamoto K, et al. Pathology of hepatocellular carcinoma in Japan. 232 consecutive cases autopsied in ten years. Cancer. 1983;51:863–77.

    Article  CAS  PubMed  Google Scholar 

  88. Momoi H, Shimahara Y, Terajima H, et al. Management of adrenal metastasis from hepatocellular carcinoma. Surg Today. 2002;32:1035–41.

    Article  PubMed  Google Scholar 

  89. Park JS, Yoon DS, Kim KS, et al. What is the best treatment modality for adrenal metastasis from hepatocellular carcinoma? J Surg Oncol. 2007;96:32–6.

    Article  PubMed  Google Scholar 

  90. Taniai N, Egami K, Wada M, Tajiri T, Onda M. Adrenal metastasis from hepatocellular carcinoma: report of 3 cases. Hepato-Gastroenterology. 1999;46:2523–8.

    CAS  PubMed  Google Scholar 

  91. Shibata T, Maetani Y, Ametani F, et al. Percutaneous ethanol injection for treatment of adrenal metastasis from hepatocellular carcinoma. Am J Roentgenol. 2000;174:333–5.

    Article  CAS  Google Scholar 

  92. Yamakado K, Anai H, Takaki H, et al. Adrenal metastasis from hepatocellular carcinoma: radiofrequency ablation combined with adrenal arterial chemoembolization in six patients. Am J Roentgenol. 2009;192:300–5.

    Article  Google Scholar 

  93. Zeng ZC, Tang ZY, Fan J, et al. Radiation therapy for adrenal gland metastases from hepatocellular carcinoma. Jpn J Clin Oncol. 2005;35:61–7.

    Article  PubMed  Google Scholar 

  94. Zhou LY, Zeng ZC, Fan J, et al. Radiotherapy treatment of adrenal gland metastases from hepatocellular carcinoma: clinical features and prognostic factors. BMC Cancer. 2014;14:878.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Chen B, Hu Y, Liu J, Cao AN, Ye LX, Zeng ZC. Respiratory motion of adrenal gland metastases: analyses using four-dimensional computed tomography images. Phys Med. 2017;38:54–8.

    Article  CAS  PubMed  Google Scholar 

  96. Yuan BY, Hu Y, Zhang L, Chen YH, Dong YY, Zeng ZC. Radiotherapy for adrenal gland metastases from hepatocellular carcinoma. Clin Transl Oncol. 2017;19(9):1154–60.

    Article  CAS  PubMed  Google Scholar 

  97. Liver Cancer Study Group of Japan. Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg. 1990;211:277–87.

    Google Scholar 

  98. Kakumu S. Trends in liver cancer researched by the Liver Cancer Study Group of Japan. Hepatol Res. 2002;24:S21–7.

    Article  Google Scholar 

  99. Ikai I, Itai Y, Okita K, et al. Report of the 15th follow-up survey of primary liver cancer. Hepatol Res. 2004;28:21–9.

    Article  PubMed  Google Scholar 

  100. Yoon KT, Kim JK, Kim DY, et al. Role of 18F-fluorodeoxyglucose positron emission tomography in detecting extrahepatic metastasis in pretreatment staging of hepatocellular carcinoma. Oncology. 2007;72:104–10.

    Article  PubMed  Google Scholar 

  101. Natsuizaka M, Omura T, Akaike T, et al. Clinical features of hepatocellular carcinoma with extrahepatic metastases. J Gastroenterol Hepatol. 2005;20:1781–7.

    Article  PubMed  Google Scholar 

  102. Taketomi A, Toshima T, Kitagawa D, et al. Predictors of extrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma. Ann Surg Oncol. 2010;17:2740–6.

    Article  PubMed  Google Scholar 

  103. Yang T, Lu JH, Lin C, et al. Concomitant lung metastasis in patients with advanced hepatocellular carcinoma. World J Gastroenterol. 2012;18:2533–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Zhang SM, Zeng ZC, Tang ZY, et al. Prognostic analysis of pulmonary metastases from hepatocellular carcinoma. Hepatol Int. 2008;2:237–43.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Zheng SS, Chen J, Wang WL, et al. Recurrence and metastasis of hepatocellular carcinoma after liver transplantation: single center experiences. Zhonghua Wai Ke Za Zhi. 2008;46:1609–13.

    PubMed  Google Scholar 

  106. Zhang M, Dai C, Zhu H, et al. Cyclophilin A promotes human hepatocellular carcinoma cell metastasis via regulation of MMP3 and MMP9. Mol Cell Biochem. 2011;357:387–95.

    Article  CAS  PubMed  Google Scholar 

  107. Duan F, Wang MQ, Liu FY, et al. Sorafenib in combination with transarterial chemoembolization and bronchial arterial chemoinfusion in the treatment of hepatocellular carcinoma with pulmonary metastasis. Asia Pac J Clin Oncol. 2012;8:156–63.

    Article  PubMed  Google Scholar 

  108. Hu HT, Yao QJ, Meng YL, Li HL, Zhang H, Luo JP, Guo CY, Geng X. Arsenic trioxide intravenous infusion combined with transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with pulmonary metastasis: long-term outcome analysis. J Gastroenterol Hepatol. 2017;32(2):295–300.

    Article  PubMed  CAS  Google Scholar 

  109. Katamura Y, Aikata H, Kimura Y, et al. Successful treatment of pulmonary metastases associated with advanced hepatocellular carcinoma by systemic 5-fluorouracil combined with interferon-alpha in a hemodialysis patient. Hepatol Res. 2009;39:415–20.

    Article  CAS  PubMed  Google Scholar 

  110. Tomokuni A, Marubashi S, Nagano H, et al. A case of complete response to S-1 therapy for multiple pulmonary recurrences of hepatocellular carcinoma after hepatic resection. Gan To Kagaku Ryoho. 2009;36:2383–5.

    PubMed  Google Scholar 

  111. Koyama J, Honjo S, Morizono R, et al. Hepatocellular carcinoma with multiple lung metastasis resulting in long-term disease-free survival by transcatheter arterial infusion chemotherapy of SMANCS. Gan To Kagaku Ryoho. 2011;38:461–4.

    PubMed  Google Scholar 

  112. Vogl TJ, Naguib NN, Gruber-Rouh T, et al. Microwave ablation therapy: clinical utility in treatment of pulmonary metastases. Radiology. 2011;261:643–51.

    Article  PubMed  Google Scholar 

  113. Hiraki T, Gobara H, Mimura H, et al. Long-term survival after radiofrequency ablation for pulmonary metastasis from hepatocellular carcinoma: report of two cases. J Vasc Interv Radiol. 2009;20:1106–7.

    Article  PubMed  Google Scholar 

  114. Jiang W, Zeng ZC, Zhang JY, et al. Palliative radiation therapy for pulmonary metastases from hepatocellular carcinoma. Clin Exp Metastasis. 2012;29:197–205.

    Article  CAS  PubMed  Google Scholar 

  115. Sun TW, He J, Zhang SM, Sun J, Zeng MS, Zeng ZC. Simultaneous multitarget radiotherapy using helical tomotherapy and its combination with sorafenib for pulmonary metastases from hepatocellular carcinoma. Oncotarget. 2016;7(30):48586–99.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Jang JW, Kay CS, You CR, et al. Simultaneous multitarget irradiation using helical tomotherapy for advanced hepatocellular carcinoma with multiple extrahepatic metastases. Int J Radiat Oncol Biol Phys. 2009;74:412–8.

    Article  PubMed  Google Scholar 

  117. Kim JY, Kay CS, Kim YS, et al. Helical tomotherapy for simultaneous multitarget radiotherapy for pulmonary metastasis. Int J Radiat Oncol Biol Phys. 2009;75:703–10.

    Article  PubMed  Google Scholar 

  118. Okuma K, Yamashita H, Niibe Y, et al. Abscopal effect of radiation on lung metastases of hepatocellular carcinoma: a case report. J Med Case Rep. 2011;5:111.

    Article  PubMed  PubMed Central  Google Scholar 

  119. Hodge JW, Sharp HJ, Gameiro SR. Cancer Abscopal regression of antigen disparate tumors by antigen cascade after systemic tumor vaccination in combination with local tumor radiation. Biother Radiopharm. 2012;27:12–22.

    CAS  Google Scholar 

  120. Lin G, Xiao H, Zeng Z, Xu Z, He J, Sun T, Liu J, Guo G, Ji W, Hu Y. Constraints for symptomatic radiation pneumonitis of helical tomotherapy hypofractionated simultaneous multitarget radiotherapy for pulmonary metastasis from hepatocellular carcinoma. Radiother Oncol. 2017;123(2):246–50.

    Article  PubMed  Google Scholar 

  121. Kim M, Na DL, Park SH, et al. Nervous system involvement by metastatic hepatocellular carcinoma. J Neuro-Oncol. 1998;36:85–90.

    Article  CAS  Google Scholar 

  122. Chang L, Chen YL, Kao MC. Intracranial metastasis of hepatocellular carcinoma: review of 45 cases. Surg Neurol. 2004;62:172–7.

    Article  PubMed  Google Scholar 

  123. Chen SF, Tsai NW, Lui CC, et al. Hepatocellular carcinoma presenting as nervous system involvement. Eur J Neurol. 2007;14:408–12.

    Article  PubMed  Google Scholar 

  124. Choi HJ, Cho BC, Sohn JH, et al. Brain metastases from hepatocellular carcinoma: prognostic factors and outcome: brain metastasis from HCC. J Neuro-Oncol. 2009;91:307–13.

    Article  Google Scholar 

  125. Shao YY, Lu LC, Cheng AL, Hsu CH. Increasing incidence of brain metastasis in patients with advanced hepatocellular carcinoma in the era of antiangiogenic targeted therapy. Oncologist. 2011;16:82–6.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Jiang XB, Ke C, Zhang GH, et al. Brain metastases from hepatocellular carcinoma:clinical features and prognostic factors. BMC Cancer. 2012;12:49.

    Article  PubMed  PubMed Central  Google Scholar 

  127. Qiu SJ, Zeng ZC, Chen J, et al. Clinical features and prognosis of patients with brain metastasis from hepatocellular carcinoma. Chin J Cancer Prev Treat. 2013;20:1924–7.

    Google Scholar 

  128. Han MS, Moon KS, Lee KH, et al. Brain metastasis from hepatocellular carcinoma: the role of surgery as a prognostic factor. BMC Cancer. 2013;13:567.

    Article  PubMed  PubMed Central  Google Scholar 

  129. Nam HC, Sung PS, Song DS, et al. Control of intracranial disease is associated with improved survival in patients with brain metastasis from hepatocellular carcinoma. Int J Clin Oncol. 2019;24:666–76.

    Article  CAS  PubMed  Google Scholar 

  130. Hsieh MJ, Lu CH, Tsai NW, et al. Prediction, clinical characteristics and prognosis of intracerebral hemorrhage in hepatocellular carcinoma patients with intracerebral metastasis. J Clin Neurosci. 2009;16:394–8.

    Article  PubMed  Google Scholar 

  131. Hsiao SY, Chen SF, Chang CC, et al. Central nervous system involvement in hepatocellular carcinoma: clinical characteristics and comparison of intracranial and spinal metastatic groups. J Clin Neurosci. 2011;18:364–8.

    Article  PubMed  Google Scholar 

  132. Kwak MS, Lee JH, Yoon JH, et al. Risk factors, clinical features, and prognosis of the hepatocellular carcinoma with peritoneal metastasis. Dig Dis Sci. 2012;57:813–9.

    Article  PubMed  Google Scholar 

  133. Yeh CN, Chen MF. Resection of peritoneal implantation of hepatocellular carcinoma after hepatic resection: risk factors and prognostic analysis. World J Surg. 2004;28:382–6.

    Article  PubMed  Google Scholar 

  134. Yeh CN, Chen MF, Jeng LB. Resection of peritoneal implantation from hepatocellular carcinoma. Ann Surg Oncol. 2002;9:863–8.

    Article  PubMed  Google Scholar 

  135. Ryu JK, Lee SB, Kim KH, Yoh KT. Surgical treatment in a patient with multiple implanted intraperitoneal metastases after resection of ruptured large hepatocellular carcinoma. Hepato-Gastroenterology. 2004;51:239–42.

    PubMed  Google Scholar 

  136. Moon DB, Hwang S, Wang HJ, et al. Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: a korean multicenter study. World J Surg. 2013;37:443–51.

    Article  PubMed  Google Scholar 

  137. Liu QY, Lai DM, Liu C, et al. A special recurrent pattern in small hepatocellular carcinoma after treatment: bile duct tumor thrombus formation. World J Gastroenterol. 2011;17:4817–24.

    Article  PubMed  PubMed Central  Google Scholar 

  138. Wang YD, Xue HZ, Jiang QF, et al. Surgical operation and re-operation for hepatocellular carcinoma with bile duct thrombosis. Chin Med J. 2010;123:2163–70.

    PubMed  Google Scholar 

  139. Yu XH, Xu LB, Liu C. Clinicopathological characteristics of 20 cases of hepatocellular carcinoma with bile duct tumor thrombi. Dig Dis Sci. 2011;56:252–9.

    Article  PubMed  Google Scholar 

  140. Buskirk SJ, Gunderson LL, Schild SF. Analysis of patterns of failure following curative irradiation of extrahepatic bile duct carcinoma. Ann Surg. 1992;215:125–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  141. Jiang T, Zeng ZC, Yang P, Hu Y. Exploration of superior modality: safety and efficacy of hypofractioned image-guided intensity modulated radiation therapy in patients with unresectable but confined intrahepatic hepatocellular carcinoma. Can J Gastroenterol Hepatol. 2017;2017:6267981.

    Article  PubMed  PubMed Central  Google Scholar 

  142. Zhang HG, Yang P, Jiang T, Zhang JY, Jin XJ, Hu Y, Sun J, Du SS, Zeng ZC. Lymphopenia is associated with gross target volumes and fractions in hepatocellular carcinoma patients treated with external beam radiation therapy and also indicates worse overall survival. Can J Gastroenterol Hepatol. 2019;2019:9691067.

    Article  PubMed  PubMed Central  Google Scholar 

  143. Zeng ZC, Tang ZY, et al. A comparison of chemoembolization combination with and without radiotherapy for unresectable hepatocellular carcinoma. Cancer J. 2004;10:307–16.

    Article  PubMed  Google Scholar 

  144. Huo YR, Eslick GD. Transcatheter arterial chemoembolization plus radiotherapy compared with chemoembolization alone for hepatocellular carcinoma: a systematic review and meta-analysis. JAMA Oncol. 2015;1(6):756–65.

    Article  PubMed  Google Scholar 

  145. Kitano K, Murayama T, Sakamoto M, et al. Outcome and survival analysis of pulmonary metastasectomy for hepatocellular carcinoma. Eur J Cardiothorac Surg. 2012;41:376–82.

    Article  PubMed  Google Scholar 

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  1. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China

    Zhao-Chong Zeng & Qian-Qian Zhao

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  1. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Jinsil Seong

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Zeng, ZC., Zhao, QQ. (2021). Palliative Radiotherapy. In: Seong, J. (eds) Radiotherapy of Liver Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-16-1815-4_17

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