Treatment completion, symptom response, and survival after palliative liver-directed radiotherapy: a retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Prior studies have shown that palliative liver-directed radiotherapy alleviates pain in patients with hepatocellular carcinoma (HCC) and liver metastases. These findings highlight the need to identify factors associated with treatment completion and survival. We evaluated factors associated with outcomes in patients receiving palliative liver-directed radiotherapy. Methods: We retrospectively analyzed 42 patients with HCC, intrahepatic cholangiocarcinoma, or liver metastases who received palliative radiotherapy at our institution between 2013 and 2024. A query of all patients in the electronic health record who received liver-directed palliative radiotherapy for these tumor types was conducted to find eligible patients. Baseline characteristics, laboratory values, and treatment details were collected. Baseline laboratory tests were taken within 48 h before the start of radiotherapy. The primary objective was to evaluate safety (acute and late adverse events) and efficacy (patient-reported pain response, bleeding stabilization, consolidative treatment response, and thrombus control). Adverse events were defined as any radiotherapy-related complications. Factors associated with survival and treatment completion were evaluated. The dose and fractionation of the radiotherapy regimens included: 8 Gy in 1 fraction, 20 Gy in 5 fractions, and 30 Gy in 10 fractions. Treatment completion was defined as completion of the prescribed radiotherapy dose and fractionation, and follow-up was conducted by the clinical team, including medical and radiation oncologists. Results: Twenty-eight (67%) patients had pain at baseline. Among 25 evaluable patients, pain improved in 17 (68%) within 1 month after receiving radiotherapy. Among 18 evaluable patients at 1-3 months after receiving radiotherapy, pain improved in 11 (61%) and was stable in 5 (28%). The acute grade 3 adverse event rate was 5%, with no acute grade 4+ adverse events or any late adverse events observed. The median overall survival was 3 months [95% confidence interval (CI): 1.73-10.30], and the median follow-up time was 1.8 months. A higher baseline albumin-bilirubin (ALBI) score was associated with shorter overall survival (hazard ratio 3.65, 95% CI: 1.83-7.28; P<0.001) and greater likelihood of not completing the prescribed radiotherapy course (odds ratio 4.36, 95% CI: 1.19-27.44; P=0.02). Six patients did not complete palliative radiation treatment due to clinical decline (n=3) or worsening liver function (n=3). Thirty-one deaths were documented during follow-up. Conclusions: Palliative liver-directed radiotherapy was well tolerated and associated with early pain improvement across different tumor histologies. Baseline clinical factors, along with ALBI score, may be associated with survival and treatment completion.
Institution: The University of Texas MD Anderson Cancer Center
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224087895