When hepatocellular carcinoma spreads to the lymph nodes, it is classified as advanced liver cancer, typically requiring systemic treatment such as targeted therapies or immunotherapy. However, a new systematic review reveals that adding radiation therapy can shrink or completely clear lymph-node tumors in roughly three out of four patients.
Korea University Ansan Hospital announced on Sept. 7 that a research team led by Prof. Lim Chae-hong of the Department of Radiation Oncology—along with Hwang Soo-young, an intern at Korea University Anam Hospital, and Heo Se-woon, a student researcher at Korea University College of Medicine—conducted a comprehensive analysis evaluating radiation therapy outcomes in liver cancer patients with lymph-node metastases. Their findings were published in Cancer Research and Treatment, the official journal of the Korean Cancer Association.
Lymph-node metastasis occurs in approximately 5% to 7% of patients with hepatocellular carcinoma. Because surgery is rarely an option at this stage and systemic therapies alone do not always sufficiently reduce metastatic lesions, clinicians have continued to investigate how local interventions like radiation can best be integrated into treatment plans.
Strong Response Rates with High-Dose Delivery
The research team pooled data from 12 studies conducted across South Korea, China, and Japan through April 2024, encompassing 825 patients. The analysis evaluated several radiation delivery techniques, including intensity-modulated radiation therapy (IMRT), three-dimensional conformal radiation therapy (3D-CRT), and stereotactic body radiation therapy (SBRT).
Across all subjects, the overall tumor response rate—defined as cases where lymph-node lesions either completely disappeared or shrank significantly on imaging—was 75.1%. Outcomes varied notably by radiation dosage: studies utilizing high-dose radiation therapy achieved a pooled response rate of 83.8%, compared with 55.6% in the low-dose group.
While the synthesis of previously published studies cannot definitively prove direct causation between higher doses and improved shrinkage, the team noted that the results support using a sufficient radiation dose provided surrounding healthy tissues are protected. Severe adverse events were relatively low, with Grade 3 or higher gastrointestinal side effects occurring in 3.7% of patients and severe thrombocytopenia in 4.2%.
Complementing Modern Systemic Treatment
The study provides quantitative evidence supporting local radiation therapy as a complementary tool alongside broader systemic regimens, rather than a replacement. Treatment decisions will continue to depend on individual factors, including baseline liver function, primary tumor status, and the extent of lymphatic spread.
"For liver cancer with lymph-node metastasis, treatment strategies must be carefully tailored," said Prof. Lim Chae-hong. "This study provides meaningful clinical evidence supporting the active consideration of radiation therapy for these patients. As systemic options like immunotherapy advance rapidly, future research will focus on developing optimal combination strategies to further enhance overall patient outcomes."
