1. Cancer Hospital & Institute, Chinese Academy of Medical Sciences
Survival Benefit with IMRT Following Narrow-Margin Hepatectomy in Patients with Hepatocellular Carcinoma Close to Major Vessels
Z. Wang, W. Wang, J. Wu, Y. Li
Cancer Hospital & Institute, Chinese Academy of Medical Sciences

2. Background
For patients with HCC close to major vessels, potential R1 resections occur frequently
(Couinaud segments IV, V and VIII), (Couinaud segments II, III, VI and VII)
Our study examines the prognostic significance of postoperative IMRT in patients with narrow-margin (<1.0 cm) hepatectomy

3. Methods Group A (n = 33) Group B (n = 83) Group C (n = 65)
Inclusion criteria
Without any neoadjuvant or adjuvant treatments except for postoperative IMRT
Macroscopically complete tumor removal
Preoperative Child–Pugh class A
ECOG Performance Status ≤ 1
Absence of distant metastasis
Group A (n = 33)
narrow-margin (<1.0 cm) hepatectomy + IMRT
surgeons have to carefully dissect and peel the tumor away from the vascular surface because the tumor has adhered to the vessels.
Advances in surgical techniques and preoperative planning have led to the development of null-margin (no real resection margin) resections, a special type of R1 resection, where surgeons carefully dissect and peel the tumor away from the vascular surface (14, 15). Null-margin resections of centrally located liver lesions have been reported to be as safe as conventional R0 surgeries
Group B (n = 83)
narrow-margin hepatectomy alone
Group C (n = 65)
wide-margin (≥1.0 cm) hepatectomy

4. Results OS DFS ER (<18 months) Intrahepatic recurrence
Extrahepatic recurrence
Marginal
Nodular
Diffuse
Group A*
89.1%
64.2%
18.2%
0.0%
30.3%
6.1%
9.1%
Group B
67.7%
52.2%
43.4%
9.6%
13.3%
21.7%
20.5%
Group C
86.0%
60.1%
16.9%
3.1%
20.0%
9.2%
*No patient developed radiation-induced liver disease

5. Conclusions
Postoperative IMRT following narrow-margin hepatectomy may be a favorable therapy for both its clinical benefit and safety profile
Moreover, this treatment is equally effective as wide-margin hepatectomy