EFFECTIVENESS OF PALLIATIVE HYPOFRACTIONATED RADIOTHERAPY 21GY IN 7 FX FOR SYMPTOMATIC HEPATOCELLULAR CARCINOMA AND LIVER METASTASIS

Abstract

Objectives: To address the gap in evidence regarding the effectiveness of a short-course hypofractionated radiotherapy protocol (21 Gy in 7 fractions) in providing pain relief for patients with symptomatic HCC or liver metastases who are not candidates for curative therapies. Materials and Methods: After CPSP and CMH Rawalpindi ethical approval, patients underwent CT simulation and received 21 Gy in 7 fractions using 6-MV LINAC-IMRT with image guidance. Pain was assessed by VAS at baseline, 1 and 3 months, with response defined as ≥2-point reduction without increased analgesic use. Clinical outcomes and supportive care were monitored, and data were analyzed using SPSS v25 with appropriate descriptive and paired statistical tests. Results: Among 23 patients (mean age 42.3±9.63 years), 60.9% were male. Hepatocellular carcinoma was present in 69.6%, and most had moderate-to-severe pain. Mean VAS pain score decreased from 7.03±1.35 at baseline to 4.17±1.62 at 1 month and 3.25±1.83 at 3 months (p=0.00). Bleeding scores also significantly decreased from 5.15±1.48 to 2.45±1.27 and 2.04±1.23 at 1 and 3 months, respectively (p=0.00). Responders were 60.9% at 1 month and 47.8% at 3 months. Conclusion: It was concluded that palliative hypofractionated radiotherapy (21 Gy in 7 fractions) significantly reduced pain and bleeding in patients with HCC and liver metastases at 1 and 3 months, supporting its feasibility and effectiveness for symptom relief in advanced hepatic malignancies.