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Three-dimensional conformal radiotherapy for the treatment of arteriovenous shunting in patients with hepatocellular carcinoma

Department of ¹Radiation Oncology ²Radiology and ³Hepato-Gastroenterology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, ⁴ School of Medicine, Chang Gung University College of Medicine, Kaohsiung, ⁵ School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung, ⁶ Department of Radiation Oncology, Yuan's General Hospital, Kaohsiung, Taiwan

Correspondence: Dr Hsuan-Chih Hsu, Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsung Medical Center, 123, Ta-Pei Road, Niao Sung Hsian, Kaohsiung 807, Taiwan. E-mail: hsuan5{at}ms65.hinet.net

The objective of this study is to evaluate the efficacy of radiotherapy for the treatment of arteriovenous shunting (AVS) in patients with hepatocellular carcinoma (HCC). Between November 1997 and April 2005, 20 HCC patients with AVS were referred to our department for radiotherapy. The radiation was delivered with 10–15 MV X-ray given 5 days per week at 22.5 Gy per fraction. Total doses ranged from 45 to 64 Gy (median dose 60 Gy). The patients were followed up with color Doppler sonography. When non-invasive imaging suggested obliteration, X-ray angiography was performed to verify the results. Four of the 20 AVS proved to be completely obliterated at X-ray angiography in 1.9, 2.8, 1.8 and 2.9 months after radiotherapy. One of the remaining 16 showed obvious regression on Doppler sonography 0.5 months after radiotherapy, but X-ray angiography was not performed to verify the result. Radiation-related hepatic failure did not occur during the follow-up period. In conclusion, radiotherapy is a treatment alternative for AVS in HCC patients and gives patients with poor prognosis the chance to receive further transcatheter arterial embolization.