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Quality of life study shows radiation can improve pain management for liver cancer patients

An understudied type of cancer receives new attention, with the potential to treat tumours that have spread to other parts of the body

Oral presentation at the ASCO Gastrointestinal Cancer Symposium 2023 of results for the Canadian Cancer Trials Group (CCTG) HE1 phase III study of palliative radiation therapy for symptomatic hepatocellular carcinoma and liver metastases.

This Canadian study investigated whether one dose of palliative radiation therapy directed to the liver in combination with the standard, best supportive care could help to reduce pain and discomfort for patients with end-stage primary or metastatic liver cancer. This patient population are often not a good fit for standard therapies, and experience pain that cannot be controlled well with pain medication alone. The goal of a palliative radiation intervention is to improve pain management and quality of life.

Dr Laura Dawson HE1 study chair
Dr Laura Dawson HE1 study chair

“This study found that one treatment of simple radiation therapy delivered to the liver resulted in clinically important and statistically significant reduction in patient reported pain one month following treatment,” says Dr Laura Dawson, the HE1 study chair and a Radiation Oncologist at Princess Margaret Hospital, UHN. “The majority of patients treated experienced reduced pain that allowed them to enjoy more quality time near the end of their life.”

Sometimes radiation therapy is given in the “palliative” setting to treat discomfort and not necessarily to shrink or eliminate a tumour. Palliative radiation therapy is often given when patients have painful bone tumours but has not been widely used to address liver cancer pain. The study concludes that for these patients, low dose radiation should be considered a standard palliative intervention. It is a simple treatment not reliant on any specific radiation technology, and an option for any center with a radiation treatment unit — potentially improving the quality of life for patients with hepatic cancer pain globally.

A family member of a study participant stated, “I believe in my heart that the radiation treatment given to (my husband) … gave him at least another 6 weeks of a good quality of life that he might not otherwise have had.”

The trial was funded in part with a grant from the Canadian Cancer Society (CCS) to accelerate and focus the knowledge gained from scientific findings into outcomes resulting in the reduced burden or enhanced quality of life for people with cancer.

“CCS is proud to support CCTG and to continue funding scientifically excellent research that places people at its core,” says Dr Stuart Edmonds, Executive Vice-President of Mission, Research and Advocacy at CCS. “We are grateful to our donors who played a role in supporting this impactful clinical trial that has potential to benefit not just people with cancer in Canada but around the world.”

HE1 results

This multicenter Canadian phase III randomized controlled trial in patients with locally advanced, end-stage, painful primary or metastatic liver cancer (59% with an ECOG performance status of 2 or 3, 26% with impaired liver function, Child-Pugh B or C), found that a single fraction of low dose radiation therapy to the liver led to a significant and clinically important improvement in pain at 4 weeks, compared to best supportive care alone. Using the brief pain inventory, patient reported pain at worst (in the past 24 hours) was improved by 2 points or more on a scale from 0-10 in 67% of patients receiving radiation therapy, compared to 22% receiving best supportive care alone (p=0.004). There was a trend for improved 3-month survival with radiation therapy (51% versus 33% for best supportive care alone, p=0.07).