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Abstract Background: This study observed the clinical outcome of radiotherapy to extensive intrahepatic targets for advanced hepatocellular carcinoma (HCC) in a single institution. Methods: From September 2009 to July 2021, patients who underwent fractionated radiotherapy to a planning target volume (PTV) of over 100 ml with biological effective dose >30 Gy 10 for advanced HCC were enrolled. Overall survival (OS) and radiation-induced liver toxicity (RILD) were evaluated. RILD was defined as an increase in Child-Pugh (CP) score ≥2 or liver function tests ≥2.5 times at 3 months after the end of radiotherapy. Results: A total of 136 patients were evaluated. Eighty-nine patients had portal vein tumor thrombus (PVTT), 37 patients were in CP B stage, and the median radiation dose to PTV was 48.8 Gy 10 . The median OS was 12.3 months. The factors most affecting OS were PVTT ( P = 0.001), PTV (>500 ml, P = 0.001), incomplete coverage of the intrahepatic tumor ( P = 0.004), and CP B ( P = 0.006) in Cox regression. RILD occurred in 22.4% of the patients and was affected by PVTT ( P = 0.003), PTV ( P = 0.010), pretreatment bilirubin levels (>1.5 mg/ml, P = 0.016), and the mean normal liver dose (MNLD) (≥ EQD 2 18 Gy 3 , P = 0.021) in binary logistic regression. As the PTV was in excess of >500 ml, RILD developed in 30.2% of patients and the prognostic importance of pretreatment bilirubin levels ( P = 0.006) and the MNLD ( P = 0.014) increased. Conclusions: As PTV is more extensive, the bilirubin level and the MNLD have to be taken into consideration for safe radiotherapy, in addition to the traditional prognostic factors.
Park et al. (Fri,) studied this question.