Early α-fetoprotein response as a predictor for clinical outcome after localized concurrent chemoradiotherapy for advanced hepatocellular carcinoma

Abstract

Backgrounds: There are limitations in using only radiological criteria to evaluate treatment outcomes in hepatocellular carcinoma (HCC). α‐fetoprotein (AFP) is regarded as an indicator of tumour activity in HCC. Aims: We present a novel correlation between AFP response and survival outcome in patients treated with localized concurrent chemoradiotherapy (CCRT). Materials: From 2005 to 2008, 187 locally advanced HCC patients underwent localized CCRT (external beam radiotherapy at 45 Gy over 5 weeks plus a concurrent hepatic arterial infusion of 5‐fluorouracil during the first/fifth week), followed by repetitive hepatic arterial infusional chemotherapy (HAIC) with 5‐fluorouracil and cisplatin. Among them, 149 with an elevated baseline AFP level (>20 ng/ml) were finally studied. AFP response was defined as >50% decrease from baseline, 1 month after the completion of localized CCRT. Results: Patients' characteristics were as follows: median age (52 years); Child–Pugh class A/B (n=137/12 respectively); and portal vein thrombosis (n=118). AFP responders (101 patients) had better objective responses than AFP non‐responders (48 patients) after CCRT (44.5 vs. 12.5%; PPPPP<0.001). Conclusions: Early AFP response may be useful not only in predicting prognosis and treatment response but also in establishing optimized treatment plans for HCC.