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Forty elderly patients aged ≥70 years treated with RT from 2015–2023 were retrospectively reviewed. Comorbidity was measured using the Charlson Comorbidity Index (CCI); survival was estimated with Kaplan–Meier methods. RT showed acceptable efficacy and low toxicity, with 1-year local progression-free survival and overall survival of 74% and 81%, and 3-year rates of 44% and 52%. 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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon 14584, Republic of Korea  \n2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon 14584, Republic of Korea; [liverkys@schmc.ac.kr](liverkys@schmc.ac.kr) (Y.S.K.)  \n3 Department of Radiology, Soonchunhyang University College of Medicine, Bucheon 14584, Republic of Korea  \n4 Department of General Surgery, Soonchunhyang University College of Medicine, Bucheon 14584, Republic of Korea  \n5 Division of Hematology-Oncology, Soonchunhyang University College of Medicine, Bucheon 14584, Republic of Korea  \n* Correspondence: [gurigurihaia@hanmail.net](gurigurihaia@hanmail.net); Tel.: +82-32-621-5877; Fax: +82-32-621-6950  \nSimple Summary  \nThe incidence of hepatocellular carcinoma (HCC) is increasing among elderly populations, and its management in these patients has become a globally emerging issue. Elderly patients often present with multiple comorbidities that affect treatment tolerance and outcomes, and the optimal management strategy for elderly patients with HCC has not yet been established. This study is the first to assess comorbidities in elderly patients using the Charlson Comorbidity Index (CCI) and to investigate the treatment outcomes of radiotherapy (RT) for liver-confined HCC. RT appears to provide acceptable efficacy and low toxicity in elderly patients aged ≥70 years with comorbidities. CCI scores maybe associated with survival and toxicity outcomes; however, further clinical studies are needed to confirm their clinical significance.  \nAbstract  \nBackground: Globally, the incidence rate of hepatocellular carcinoma (HCC) has increased among elderly patients. Elderly patients often present with multiple comorbidities that affect treatment tolerance and outcomes, and the optimal management strategy for this population has not yet been established. Therefore, we assessed comorbidities in elderly patients and investigated the treatment outcomes of radiotherapy (RT) to liver-confined HCC. Methods: We retrospectively reviewed 40 elderly patients aged ≥70 years with liver-confined HCC, who were treated with RT between 2015 and 2023 . Comorbidity was assessed by using the Charlson Comorbidity Index (CCI) . Survival outcomes were analyzed using the Kaplan–Meier method. Results: The median age was 75 years (range, 70–87 years) . The Barcelona Clinic Liver Cancer stage was 0 in 7 patients, A in 10 patients, B in 9 patients, and C in 14 patients. Most patients (85%) had Child–Pugh class A hepatic function before RT. The CCI scores ranged from 2 to 9 (median, 5) . Various RT techniques were applied according to patients’ condition, tumor burden, and treatment aim: threedimensional conformal radiotherapy in four patients, intensity-modulated radiotherapy in 20 patients; and stereotactic body radiotherapy in 16 patients. RT was delivered with radical intent in 30 patients and with palliative intent in 10 patients. The median biological effective dose calculated with an α/β ratio of 10 was 53.7 Gy 10 (range, 39–134.4 Gy 10) .  \nThe median follow-up period after RT was 18 months. The 1-year local progression-free survival and overall survival (OS) rates were 74% and 81%, respectively, and the 3-year rates were 44% and 52%, respectively. Patients with CCI \u003C 5 had more favorable O","cbCaiuw6pAuthFip","https://ap.wps.com/l/cbCaiuw6pAuthFip","pdf",1704591,14,"English","# Introduction\n## Burden of hepatocellular carcinoma in elderly patients\n## Defining “elderly” and need for comorbidity assessment\n## Charlson Comorbidity Index in clinical risk stratification\n# Abstract\n## Background\n## Methods\n## Results\n## Conclusions","[{\"question\":\"How were comorbidities assessed in the elderly patients?\",\"answer\":\"Comorbidities were assessed using the Charlson Comorbidity Index (CCI). Higher CCI scores indicate more severe comorbid conditions.\"},{\"question\":\"What radiotherapy techniques and treatment intents were used?\",\"answer\":\"Various RT techniques were selected based on patient condition, tumor burden, and treatment aim, including 3D conformal RT, intensity-modulated radiotherapy, and stereotactic body radiotherapy. RT was delivered with radical intent in 30 patients and palliative intent in 10 patients.\"},{\"question\":\"What survival outcomes were reported after radiotherapy?\",\"answer\":\"After a median follow-up of 18 months, the 1-year local progression-free survival and overall survival rates were 74% and 81%, respectively, while the 3-year rates were 44% and 52%.\"}]","Radiotherapy for Liver-Confined Hepatocellular Carcinoma in Elderly Patients with Comorbidity | PDF",1790768813,35]