Association between changes in serum α-fetoprotein level and patterns of recurrence in patients undergoing carbon-ion radiotherapy for hepatocellular carcinoma
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This study aims to assess the usefulness of monitoring serum α-fetoprotein (AFP) levels for predicting recurrence patterns in patients with hepatocellular carcinoma (HCC) treated with carbon-ion radiotherapy.
Consecutive 157 HCCs treated with definitive carbon-ion radiotherapy between April 1995 and March 2003 were evaluated. Serum AFP levels were measured before and at 3, 6, 12, and 18 months after treatment. Patterns of recurrence were categorized as local (in field), intrahepatic, or distant. Associations between clinical data and onset of recurrence were analyzed. Patients with AFP level of >20 ng/ml were defined as AFP positive.
Follow-up periods were 4.1–66 months (median 35.4 months). Only in the AFP-positive patients, AFP reelevation was associated with the development of recurrence (p = 0.00). Although not statistically significant, patterns of AFP change tended to differ between intrahepatic failure and local failure; AFP levels tended to reelevate earlier in patients developing local failure. Pretreatment AFP of >50 ng/ml (p = 0.00) and total bilirubin of >1.6 mg/dl (p = 0.04) were predictive of development of intrahepatic recurrence within 6 months. AFP of >60 ng/ml (p = 0.00) and platelet of <70,000/mm3 (p = 0.01) were predictive of development of distant metastasis.
AFP monitoring was useful for patients with HCC treated with carbon-ion radiotherapy. Early AFP reelevation was suggestive of in-field local recurrence.
KeywordsCarbon-ion radiotherapy Hepatocellular carcinoma α-Fetoprotein Charged particle
Conflict of interest
Takeshi Yanagi, Shigeo Yasuda, Hiroshi Imada, Shigeru Yamada, Hirotoshi Kato, Yuta Shibamoto, and Tadashi Kamada declare that they have no conflict of interest.
This retrospective study was approved by the IRB of the NIRS. All three clinical trials involved have been approved by the IRB and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent prior to their inclusion in the study.
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