Role of Radiotherapy in Improving Quality of Life in Patients with Hepatocellular Carcinoma and Liver Metastasis

Main Article Content

Saif Ur Rehman
Shafaq Maqsood
Aneela Deevan


Background: Hepatocellular carcinoma (HCC) and liver metastases (LM) are often associated with significant symptoms such as pain and abdominal discomfort, impacting the quality of life (QoL) of affected patients. Current treatments vary in effectiveness and often leave a substantial unmet medical need in symptom management.

Objective: This study aimed to assess the efficacy of external radiation therapy (ERT) in alleviating symptoms and improving the QoL in patients with HCC and LM, focusing on those presenting primarily with pain or abdominal discomfort.

Methods: After institutional review board approval, patients with HCC or painful LM, not previously treated with tumor resection, radiofrequency ablation, or systemic therapy, were included. Eligible participants exhibited symptoms such as pain, nausea, and fatigue, and had a performance status of 0-2. A single fraction dose of ERT was administered, and symptom relief was evaluated using the Brief Pain Inventory (BPI) and QoL using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30). Completion rates of these questionnaires were tracked at baseline, one week, and one month post-treatment.

Results: Of the 43 patients enrolled (23 HCC, 20 LM), significant improvement in the FACT-G TOI was observed in 34% of patients at one month post-ERT. When focusing on those with pain or abdominal discomfort, 59% reported clinically significant symptom relief. However, QoL improvement was noted in only about one quarter of patients, with one third experiencing worsening QoL at one month. Questionnaire completion rates were high initially but decreased over time, reflecting the challenging nature of the patient population.

Conclusion: ERT demonstrated potential benefits in symptom relief, particularly for pain and abdominal discomfort in patients with HCC and LM. Nonetheless, the impact on overall QoL was mixed, highlighting the need for further research into optimizing therapeutic strategies for this patient group.

Article Details

How to Cite
Saif Ur Rehman, Shafaq Maqsood, & Aneela Deevan. (2024). Role of Radiotherapy in Improving Quality of Life in Patients with Hepatocellular Carcinoma and Liver Metastasis. Journal of Health and Rehabilitation Research, 4(2), 450–455.
Author Biographies

Saif Ur Rehman, Ganga Ram Hospital Lahore Pakistan

Assistant Professor of Radiotherapy, Ganga Ram Hospital, Lahore, Pakistan

Shafaq Maqsood, Ganga Ram Hospital Lahore Pakistan

Senior Registrar, Oncology Department, Ganga Ram Hospital, Lahore, Pakistan

Aneela Deevan, Ganga Ram Hospital Lahore Pakistan

Medical Officer, Oncology Department, Ganga Ram Hospital, Lahore, Pakistan


Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.

Shannon AH, Ruff SM, Pawlik TM. Expert Insights on Current Treatments for Hepatocellular Carcinoma: Clinical and Molecular Approaches and Bottlenecks to Progress. J Hepatocell Carcinoma. 2022;9:1247–1261.

Soliman H, Ringash J, Jiang H, Singh K, Kim J, Dinniwell R, et al. Phase II Trial of Palliative Radiotherapy for Hepatocellular Carcinoma and Liver Metastases. J Clin Oncol. 2013;31:3980-3986.

Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul J, et al. EASL Clinical Practice Guidelines: Management of Hepatocellular Carcinoma. J Hepatol. 2018;69:182–236.

Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD Guidelines for the Treatment of Hepatocellular Carcinoma. Hepatology. 2018;67:358–380.

Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, et al. Asia-Pacific Clinical Practice Guidelines on the Management of Hepatocellular Carcinoma: 2017 Update. Hepatol Int. 2017;11:317–370.

Korean Liver Cancer Study Group-National Cancer Center Korea. Practice Guideline for the Management of Hepatocellular Carcinoma. Korean J Radiol. 2015;16:465–522.

Chen CP. Role of Radiotherapy in the Treatment of Hepatocellular Carcinoma. J Clin Transl Hepatol. 2019;7(2):183–190.

Bydder S, Spry NA, Christie DR, Roos D, Burmeister BH, Krawitz H, et al. A Prospective Trial of Short-Fractionation Radiotherapy for the Palliation of Liver Metastases. Australas Radiol. 2003;47:284-288.

Chow E, Harris K, Fan G, Tsao M, Sze WM. Palliative Radiotherapy Trial for Bone Metastases: A Systematic Review. J Clin Oncol. 2007;25:1423-1436.

Cleeland CS, Ryan KM. Pain Assessment: Global Use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23:129-138.

Heffernan N, Cella D, Webster K, Odam L, Martone M, Passik S, et al. Measuring Health-Related Quality of Life in Patients with Hepatobiliary Cancers: The Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire. J Clin Oncol. 2002;20(9):2229-39.

Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy Scale: Development and Validation of the General Measure. J Clin Oncol. 1993;11:570-579.

Using the Common Terminology Criteria for Adverse Events (CTCAE - Version 5.0) to Evaluate the Severity of Adverse Events of Anticancer Therapies. Actas Dermosifiliogr (Engl Ed). 2021 Jan;112(1):90-92.

Kang D, Shim S, Cho J, Lim HK. Systematic review of studies assessing the health-related quality of life of hepatocellular carcinoma patients from 2009 to 2018. Korean Journal of Radiology. 2020 Jun;21(6):633.

Choi SH, min Lee B, Kim J, Seong J. Efficacy of Stereotactic Ablative Radiotherapy in Patients with Oligometastatic Hepatocellular Carcinoma: A Phase II Study. Journal of Hepatology. 2024 Mar 11.

Tong TM, Fiocco M, van Duijn-de Vreugd JJ, Lutjeboer J, Speetjens FM, Tijl FG, Sitsen ME, Zoethout RW, Martini CH, Vahrmeijer AL, van der Meer RW. Quality of Life Analysis of Patients Treated with Percutaneous Hepatic Perfusion for Uveal Melanoma Liver Metastases. CardioVascular and Interventional Radiology. 2024 Apr 8:1-0.

Ringash J, O’Sullivan B, Bezjak A, Redelmeier DA. Interpreting Clinically Significant Changes in Patient Reported Outcomes. Cancer. 2007;110:196-202.

Tao C, Hu N, Liu Y, Wang H, Wang Z, Zhang K, Wang L, Chen B, Wu F, Rong W, Wu J. Long-term outcome of adjuvant radiotherapy upon postoperative relapse of centrally located hepatocellular carcinoma: a real-world study. Scientific Reports. 2024 Apr 12;14(1):8506.

Fan SY, Eiser C, Ho MC. Health-Related Quality of Life in Patients with Hepatocellular Carcinoma: A Systematic Review. Clin Gastroenterol Hepatol. 2010;8:559-564.