A phase III study conducted by Laura A. Dawson, MD, FRCPC, of Princess Margaret Cancer Centre, Toronto, and colleagues offered palliative radiotherapy to patients with symptomatic hepatocellular cancer and liver metastases in an attempt to alleviate their pain. The results of their study, which were presented during the 2023 American Society of Clinical Oncology (ASCO) GI Cancers Symposium (Abstract LBA492), suggest that single-fraction radiotherapy improves hepatic pain and survival better than supportive care in most patients.

This multicenter trial focused on 66 patients with painful hepatocellular carcinoma (n = 23) or liver metastases (n = 43). Participants were randomly assigned to receive best supportive care alone or with single-fraction radiotherapy at 8 Gy. Eligibility criteria required individuals to have end-stage disease and to be unsuitable for local, regional, or systemic therapies.

Of the total, 42 patients on radiotherapy (n = 24) and best supportive care (n = 18) completed assessments at baseline and 1 month; the average “pain at worst” score at baseline was 7 of 10. Approximately 67% of patients on radiotherapy reported an improved “worst” pain score after 1 month on treatment, compared with 22% of those on best supportive care (P = .004). Of note, 21% on radiotherapy and 0% on best supportive care had improved pain, with no increase in opioid use (P = .07).

There was a larger percentage of patients reporting a significant improvement in “pain at its least” (P = .03) and “percentage relief in pain by treatment” (P = .04) on radiotherapy than that of those on best supportive care. Additionally, a sensitivity analysis revealed significant improvements in “worst pain” among participants treated with radiotherapy (P = .002). Although grade 3 or higher adverse events were uncommon, 58% and 33% of individuals in the radiotherapy and best supportive care arms experienced events of at least grade 2. Of note, treatment with radiotherapy correlated with improved 3-month survival (P = .07).

Source: JNCCN