Combination of Transarterial Chemoembolization and Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma With Inferior Vena Cava Tumor Thrombus

The effectiveness of particle radiotherapy for hepatocellular carcinoma associated with inferior vena cava tumor thrombus

“…Previous studies of the use of photon radiotherapy on HCC with IVCTT have shown the radiation fields to be focused only on the IVCTT; the main tumors were not included, due to the risk of RILD [38,39,41]. However, our data indicate that total irradiation, including the main tumor and the IVCTT, can be safely performed using particle beams.…”

“…To compensate for the low antitumor effects of photon beams, a number of radiation fields are needed to deliver a sufficient tumoricidal dose, resulting in increased radiation exposure to the normal liver. Therefore, the application of photon radiotherapy for patients who have HCC with IVCTT has been restricted to small HCCs (\5 cm) or only tumor thrombi [38][39][40][41]. Conversely, the highly targeted dose distribution of particle beams exhibited by the Bragg peak enables higher radiation doses to be delivered to tumors, with reduced radiation fields.…”

Long-term surviving patient with inferior vena cava tumor thrombus and extrahepatic metastasis after spontaneous ruptured hepatocellular carcinoma

“…There have been only limited reports of the efficacy of RT for IVCTT of HCC for improvement of short-term prognosis [9][10][11][12][13]; however, there have been no reports of long-term survival cases with IVCTT of HCC treated with combined Fig. 1 a, To accomplish long-term survival in a patient with nonresectable advanced-stage HCC, it was important to control local disease rather than radical treatment.…”

“…Furthermore, it is associated with an increased risk of sudden death due to heart failure or pulmonary embolism; however, a standard treatment strategy has not been established, and the prognosis for patients is extremely poor [9]. Recently, the feasibility of a combination of transarterial chemoembolization (TACE) and radiotherapy (RT) for HCC with IVCTT was reported [10]. However, it is still uncertain whether the combination procedure improves the long-term prognosis for patients with IVCTT.…”

External radiation treatment of malignant liver disease: a critical review

“…Treatment options are limited to surgical removal of the tumor thrombus, which is often contraindicated due to diminished hepatic reserve. Given historical poor outcomes with TACE alone in this clinical setting, Koo et al [42] retrospectively compared a cohort of patients who underwent TACE and 3DCRT (median dose of 45 Gy) to 29 historical patients receiving TACE alone. Results demonstrated significant improvement in response and progression-free rates of IVCTT using the combined treatment, with improved median survival times of 11.7 versus 4.7 months, respectively.…”