# Radiotherapy for Liver-Confined Hepatocellular Carcinoma in Elderly Patients with Comorbidity

## TL;DR

Radiotherapy is a safe and effective treatment for liver cancer in elderly patients with multiple health issues.

## Contribution

This is the first study to assess comorbidities in elderly HCC patients using the Charlson Comorbidity Index and evaluate radiotherapy outcomes.

## Key findings

- Radiotherapy for liver-confined HCC in elderly patients shows acceptable efficacy and low toxicity.
- Patients with lower Charlson Comorbidity Index scores had better survival outcomes.
- Various radiotherapy techniques were used, with median follow-up showing 1-year and 3-year survival rates of 81% and 52%, respectively.

## Abstract

The incidence of hepatocellular carcinoma (HCC) is increasing among elderly populations, and its management in these patients has become a globally emerging issue. Elderly patients often present with multiple comorbidities that affect treatment tolerance and outcomes, and the optimal management strategy for elderly patients with HCC has not yet been established. This study is the first to assess comorbidities in elderly patients using the Charlson Comorbidity Index (CCI) and to investigate the treatment outcomes of radiotherapy (RT) for liver-confined HCC. RT appears to provide acceptable efficacy and low toxicity in elderly patients aged ≥70 years with comorbidities. CCI scores may be associated with survival and toxicity outcomes; however, further clinical studies are needed to confirm their clinical significance.

Background: Globally, the incidence rate of hepatocellular carcinoma (HCC) has increased among elderly patients. Elderly patients often present with multiple comorbidities that affect treatment tolerance and outcomes, and the optimal management strategy for this population has not yet been established. Therefore, we assessed comorbidities in elderly patients and investigated the treatment outcomes of radiotherapy (RT) to liver-confined HCC. Methods: We retrospectively reviewed 40 elderly patients aged ≥70 years with liver-confined HCC, who were treated with RT between 2015 and 2023. Comorbidity was assessed by using the Charlson Comorbidity Index (CCI). Survival outcomes were analyzed using the Kaplan–Meier method. Results: The median age was 75 years (range, 70–87 years). The Barcelona Clinic Liver Cancer stage was 0 in 7 patients, A in 10 patients, B in 9 patients, and C in 14 patients. Most patients (85%) had Child–Pugh class A hepatic function before RT. The CCI scores ranged from 2 to 9 (median, 5). Various RT techniques were applied according to patients’ condition, tumor burden, and treatment aim: three-dimensional conformal radiotherapy in four patients, intensity-modulated radiotherapy in 20 patients; and stereotactic body radiotherapy in 16 patients. RT was delivered with radical intent in 30 patients and with palliative intent in 10 patients. The median biological effective dose calculated with an α/β ratio of 10 was 53.7 Gy10 (range, 39–134.4 Gy10). The median follow-up period after RT was 18 months. The 1-year local progression-free survival and overall survival (OS) rates were 74% and 81%, respectively, and the 3-year rates were 44% and 52%, respectively. Patients with CCI < 5 had more favorable OS than those with CCI ≥ 5, but the difference was not statistically significant. Conclusions: RT for liver-confined HCC appears to be a feasible treatment option for elderly patients with multiple comorbidities.