# Hepatic Reirradiation for Patients with Recurrent Hepatocellular Carcinoma
## 3 Results  
A total of 33 patients completed two courses of RT for intrahepatic HCC while 32 patients completed image evaluation; the other one patient had no image study because of lethal upper gastrointestinal bleeding. Four of these patients received the third course of RT for newly developed tumor during follow-up; one patient received the third course sequentially with full RT dose to a different tumor at the other hepatic lobe, two weeks after completing the second course. The mean follow-up was 22.4 months, ranging from 1.5 to 127.0 months. The interval between two RT courses was 16.5 months, ranging from 0.5 to 136.0 months (Table 1). No patients died within 1 month after reirradiation while one patient experienced nonclassic RILD with elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) over 200 U/L. This patient recovered from RILD and expired due to upper gastrointestinal bleeding, a complication of liver cirrhosis, eight months after the second course of RT. For all patients, the one-year OS was 62.5% and two-year OS was 34.4% (Figure 1A). In total, 30 patients experienced infiled (IF) recurrence, which was defined as reirradiated area; 19 patients had outfield (OF) recurrence, as intrahepatic but nonirradiated area, and 10 patients developed distant metastasis (DM), as extrahepatic lesions (Supplementary Figure S1). Figure 1: Overall survival for (**A**) all patients over two years and (**B**) regression disease (RD) subgroup and stable disease (SD) subgroup. _Appl. Sci._**2021**, _11_, 1598 \begin{table}
\begin{tabular}{l c c} \hline \hline  & **Characteristics** & **No. of Patients** & **\%** \\ \hline Patient & 32 & \\ Age (years) & Mean: 66.0, (32–89) & \\ Gender & & \\ Male & 29 & 90.6 \\ Female & 3 & 9.4 \\ Tumor stage & & \\ AJCC 1 (7 th ed., 2010) & & \\ T1 & 3 & 9.4 \\ T2 & 15 & 46.9 \\ T3 & 9 & 28.1 \\ T4 & 5 & 15.6 \\ BCLC 2 stage & & \\ A & 5 & 15.6 \\ B & 15 & 46.9 \\ C & 12 & 37.5 \\ Tumor numbers & & \\ One & 27 & 84.4 \\ Two & 5 & 15.6 \\ Follow-up (months) & Mean: 22.4, & \\  & (1.5–127.0) & \\ Interval between two RT courses (months) & Mean: 16.5, & \\  & (0.5–136.0) & \\ Child–Pugh score before the second RT & & \\
5 & 22 & 68.8 \\
7 & 4 & 12.5 \\ Hepatitis status & & \\ Hepatitis B & 19 & 59.4 \\ Hepatitis C & 5 & 15.6 \\ Both hepatitis B and C & 1 & 3.1 \\ Main portal vein tumor thrombosis & & \\ Present & 9 & 28.1 \\ Absent & 23 & 71.9 \\ Local therapies before RT & & \\ Nil & 11 & 34.4 \\ Operation & 2 & 6.3 \\ TACE & 7 & 21.9 \\ REA & 2 & 6.3 \\ Operation and TACE & 6 & 18.8 \\ TACE and RFA & 3 & 9.4 \\ Operation, TACE and RFA & 1 & 3.1 \\ Radiation dose of the nd RT (BED 3, \(\alpha/\beta=10\)) & Mean: 52.3 Gy, & \\  & (ranges, 12–109.5 Gy) & \\ Use of systemic therapy after the 2 nd RT & & \\ Yes & 8 & 25.0 \\ No & 24 & 75.0 \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Patient characteristics. For the treatment outcome, 8 patients had complete remission (CR) and 19 patients had partial remission (PR) at the image evaluation; these 27 patients were defined as the regressive disease (RD) subgroup. Two patients were suggestive of progressive disease and the other three had no interval change at the image evaluation; these five patients were categorized as the stable disease (SD) subgroup. Overall, one-year LC was 34.4% while two-year LC was 21.9% (Supplementary Figure S2). However, no predicting factor between RD and SD was discovered (Supplementary Table S3). Comparing RD and SD subgroups, the mean OS was 30.0 and 4.0 months, respectively, \(p\) < 0.001 (Figure 1B). Additionally, both the OS and infield progression-free survival (IF-PFS), defined as no recurrence within the reirradiated area, between CR and PR had no difference (\(p\) = 0.860 and \(p\) = 0.940) (Figure 2). Besides, Child-Pugh score before reRT was also a key factor to the OS; the median OS for the patients with score 5 and score 6 and 7 were 34.4 and 10.7 months, respectively (\(p\) = 0.005) (Figure 3).