Palliative radiation therapy improves hepatic pain in HCC and liver metastasis

Single fraction radiation therapy (RT) added to best supportive care (BSC) outperformed BSC only in reducing hepatic pain in patients with either end-stage hepatocellular carcinoma (HCC) or liver metastasis. A trend was reported towards improved survival for patients receiving RT.

“An important minority of patients with end-stage HCC and liver metastases experience hepatic pain,” said Prof. Laura Dawson (Princess Margaret Cancer Centre, Canada) [1]. She explained that systemic therapy is not swiftly effective in reducing pain and that opioids have a small therapeutic window due to a reduced clearance and underlying liver disease. A study by Soliman et al. showed that single fraction 8 Gy RT to the whole liver was safe, providing the rationale for the current study [2].

A randomised, multi-centre, phase 3 trial (NCT02511522) included 66 patients with either painful end-stage HCC (n=23) or liver metastasis (n=43) to compare palliative RT, single fraction, 8 Gy, plus BSC with BSC only [1]. The primary endpoint was the reduction of hepatic pain, defined as an improvement of at least 2 points on the ‘intensity at worst’ item of the Brief Pain Inventory (BPI) after 1 month.

The primary endpoint was met by 67% of the patients in the RT arm and by 22% of the patients in the BSC arm (P=0.004). A sensitivity analysis, treating patients without assessment at 1 month as having ‘no improvement’ still favoured the RT arm over the BSC arm (49% vs 12%; P=0.002). In addition, 21% of the patients in the RT arm achieved the primary endpoint without an increase in opioid use compared with 0% in the BSC arm, a result that trended towards significance (P=0.07). Interestingly, the authors observed a trend towards improved survival in the experimental arm, with 3-month overall survival rates of 51% and 33%, respectively (P=0.07).

“Single fraction RT improved hepatic pain in the majority of patients with painful end-stage HCC or liver metastases,” concluded Prof. Dawson. Further studies need to clarify whether there is in fact a prolonged survival for patients on RT compared with those receiving BSC only.

1. Dawson LA, et al. Canadian Cancer Trials Group HE.1: A phase III study of palliative radiotherapy for symptomatic hepatocellular carcinoma and liver metastases. LBA492, Rapid Abstract Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract, ASCO GI 2023, 19–21 January, San Francisco, CA, USA.
2. Soliman H, et al. JCO. 2013;31(31):3980–3986.

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Posted on 17 March, 202317 March, 2023