Dr Dawson on Palliative Radiotherapy in Symptomatic HCC or Liver Metastases

Laura Dawson, MD, FRCPC, clinician scientist, Princess Margaret Cancer Centre in Toronto, Ontario, Canada, discusses the investigation of palliative radiotherapy for patients with symptomatic hepatocellular carcinoma (HCC) or liver metastases.

Patients who may be nearing the end of their life suffer from burdens of cancer in the liver, whether either in the form of metastases from any solid tumors or from primary HCC, Dawson begins. Medications and palliative care can be utilized to assist patients throughout the process, but some patients still do not experience relief of symptoms, Dawson says. Additionally, underlying liver disease or impaired liver function can also make it more difficult for patients to tolerate best supportive care, Dawson adds.

A randomized trial (NCT02511522) evaluated the use of palliative radiotherapy vs best supportive care in patients with HCC or live metastases. Findings presented at the 2023 Gastrointestinal Cancers Symposium showed that single-fraction radiotherapy at 8 Gy improved hepatic pain, and investigators noted a trend toward an improvement in overall survival (OS). In an assessment using the Brief Pain Inventory, 67% of patients in the radiotherapy arm reported an improvement in worst pain, compared with 22% in the best supportive care arm (P = .004). Additionally, improvements were reported in a higher proportion of patients in the radiotherapy arm vs best supportive care for pain at its least (63% vs 28%; P = .03) and percentage relief in pain by treatment (59% vs 25%; P = .04).

The 3-month OS rate was 51% in the radiotherapy arm vs 33% in the best supportive care arm (P = .07).

Palliative radiation had previously been studied in this setting, and although is routinely used to treat bone, lung, or brain metastases, it has not yet been routinely used to treat liver metastases or HCC, Dawson says. Previously, investigators launched a single-arm study utilizing simple radiation to treat these patients, and data showed that that patient-reported pain was improved in nearly half of patients, Dawson notes. However, this study did not change practice, adding to the rationale to complete a randomized trial with this approach, Dawson notes.

The Canadian Clinical Trials group launched the randomized study, with investigators hypothesizing that most patients who received radiation would have a clinically important improvement in pain, Dawson says. Patients were randomly assigned in a 1:1 fashion to receive radiotherapy or best supportive care.