Effects of image-guided adaptive radiotherapy combined with hepatic artery chemoembolization in primary liver cancer patients

• Exploring the effects of adaptive radiotherapy combined with hepatic artery chemoembolization on liver cancer patients. • We concluded that the immune function of primary liver cancer patients is improved. • It did not increase the incidence of AEs and yielded a higher 2-year ORR and DCR. The study aimed to explore the effects of image-guided adaptive radiotherapy combined with hepatic artery chemoembolization on the immune function of primary liver cancer patients. The study included 84 primary liver cancer patients who received treatment at our hospital between April 2018 and January 2020. They were divided into the control group ( n =42, hepatic artery chemoembolization) and the study group ( n =42, image-guided adaptive radiotherapy combined with hepatic artery chemoembolization) using the random number table method. AFP, ALT, AST, CA724, CA242 and immune function before and after treatment were compared in the two groups and the short-term efficacy and adverse events (AEs) were statistically analyzed. The two groups were followed up. After treatment, the study group had a higher ORR and DCR compared to the control group, and the difference was statistically significant ( P < 0.05). There was no statistical difference in the levels of AFP, ALT, AST, CA724 and CA242 between the two groups before treatment ( P > 05). After treatment, the study group had lower levels of AFP, ALT, AST, CA724 and CA242 than the control group, and the difference was statistically significant ( P < 0.05). There was no statistical difference in the levels of CD4 + , CD8 + , and CD4 + /CD8 + before treatment in the two groups ( P > 05). After treatment, the study group had higher levels of CD4 + and CD4 + /CD8 + but lower levels of CD8 + compared to the control group, and the difference was statistically significant ( P < 0.05). In the study group, 2 patients developed radiation-induced liver disease, and the incidence was 4.76% (2/42), which occurred at 4 and 6 weeks after the end of radiotherapy, respectively. The patients mainly had elevated transaminases, ascites, and liver enlargement and hepatoprotection and nutritional support were provided, and the patients gradually recovered after treatment. There was no statistical difference in the incidence of AEs between the two groups ( p > 0.05). All patients in the study completed follow up and the follow up completion rate was 100%. The median duration of follow up was 22.5 months. In the study group, 12 of 42 patients (28.57%) died and 21 cases (50.00%) had recurrence. In the control group, 21 of 42 cases (50.00%) died and 27 cases (64.29%) recurred. At 1 year, there was no statistical difference in ORR and DCR between the two groups ( P > 0.05) and at 2 years, the study group had a higher ORR and DCR than the control group, and the difference was statistically significant ( P < 0.05). Image-guided adaptive radiotherapy combined with hepatic artery chemoembolization may improve the immune function of primary liver cancer patients and is of important clinical application value.