SPECT-Based Radiation Therapy and Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma Sized 14 cm or Greater

Purpose: To evaluate the feasibility of single photon emission computed tomography-based three-dimensional conformal radiotherapy (SPECT-B3DCRT) combined with transcatheter arterial chemoembolization (TACE) for large unresectable hepatocellular carcinoma. Methods: Twelve patients with unresectable hepatocellular carcinoma (HCC) sized 14 cm or greater underwent SPECT using Tc-99m-galactosyl human serum albumin before 3DCRT to explore the optimal irradiation beam angle to cover the clinical target volume (CTV) to a total dose of 45 Gy/18 fractions while preserving functional liver volume (FLV). The TACE was scheduled within two months after completion of 3DCRT. Results: Local control rate was 78.6% at 2 years. Median over-all survival was 10.1 months and the survival rate at 1 and 2 years was 41.7 and 33.3%, respectively. Conclusions: SPECT-B3DCRT combined with TACE appears to be tolerable and effective for patients with HCC sized 14 cm or greater in terms of local control and survival.