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Radiation therapy in combination with drug therapy for patients with advanced liver cancer can extend patients' lives and delay the progression of their tumour without a concerning increase in toxicity, a randomized phase III study found.
The study was led by and based on earlier studies conducted at the Princess Margaret Cancer Centre, and funded by the NRG Oncology, one of five national cancer cooperative groups funded by the National Cancer Institute as part of the National Clinical Trials Network.
This is the first North American randomized study focused on how radiation therapy in combination with drug treatments can help patients with advanced hepatocellular carcinoma, the most common type of liver cancer.
"We can now say without hesitation that radiation therapy is an effective treatment for patients with unresectable liver cancer that are not suitable for standard invasive or local regional therapies," says Dr. Laura Dawson, a radiation oncologist at the Princess Margaret, and the study's lead author.
Dr. Dawson presented the results of the 10-year study in San Antonio, Texas on Oct. 24 at the annual meeting of the American Society for Radiation Oncology (ASTRO), the world's largest radiation oncology society with approximately 10,000 members.
Liver cancers are the third-leading cause of cancer deaths worldwide, and liver cancer is now one of the fastest rising types of cancer in Canada. It is often diagnosed in later disease stages, when symptoms are more likely to show up.
'Very effective, especially…when it is targeted to the tumour'
The study reported on 177 patients from more than 20 oncology departments, mainly from Canada and the United States, with new or recurrent advanced liver cancer who could not have surgery. Patients were either treated with the drug sorafenib (the standard of care when the study began) or with stereotactic body radiation therapy and sorafenib.
The latter group of patients had improved survival, compared with patients who only had drug treatment (15.8 months versus 12.3 months median survival). They also had longer intervals before their cancer progressed.
"Some of the patients who had radiation therapy on the trial are still returning to my clinic more than five years after being treated and are doing very well," says Dr. Dawson. “People are well aware of surgery and drugs that treat cancer, but less aware of radiation therapy that is very effective, especially today when it is targeted to the tumour."
Dr. Dawson hopes the findings will spark increased interest in future clinical trials to study the benefit of radiation therapy in combination with new drug therapies.
Risk factors for liver cancer include cirrhosis of the liver, infection with hepatitis B or C, alcohol, and smoking tobacco. Liver disease is underdiagnosed and under-treated.
People with other conditions including non-alcoholic fatty liver disease can also be susceptible; non-alcoholic fatty liver disease affects more than seven million people in Canada.