Lancet Publication of HE1 results shows that palliative radiation can improve pain management for liver cancer patients

The Canadian led HE1 trial results, published in Lancet Oncology, confirm the quality-of-life benefits of palliative radiation therapy for symptomatic hepatocellular carcinoma and liver metastases.

“These results show 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 Cancer Centre, University Health Network and Professor and Chair of the Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto. “The majority of patients treated experienced reduced pain that allowed them to enjoy more quality time near the end of their life.” 

One dose of palliative radiation therapy directed to the liver in combination with the standard, best supportive care, reduces pain and discomfort for these patients who are often not a good fit for standard therapies. The study concludes that low dose radiation should be considered a standard palliative intervention for hepatic cancer pain. 

Following this novel, yet simple treatment to a patient with painful liver metastases, a family member 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.”

HE1 trial 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).

These results were presented at the ASCO Gastrointestinal Cancer Symposium in 2023.

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.