Hypofractionated radiotheapy using helical tomotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis

Abstract

BackgroundWe want to evaluate the efficacy of helical tomotherapy (HT) for treating advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).MethodsWe treated 35 patients for unresectable HCC combined with PVTT in whom other treatment modalities were not indicated. The tumor thrombi involved the main trunk of the portal vein in 18 patients (51.4%) and the first or second order branches in 17 patients (48.6%). A median dose of 50 Gy (range: 45–60 Gy) was delivered in 10 fractions. Capecitabine was given concomitantly at a dose of 600 mg/m2 twice daily during radiotherapy.ResultsThe responses were evaluated via computed tomography. There was a complete response (CR) in 5 patients (14.3%), partial response (PR) in 10 patients (28.6%), stable disease (SD) in 18 patients (51.4%) and progressive disease (PD) in 2 patients (5.7%). The Child-Pugh classification (A vs B) and the Japan integrated staging (JIS) score (2 vs 3) were statistically significant parameters that predicted the response of PVTT (p = 0.010 and p = 0.026, respectively). The median survival, one and two year survival rate of all patients was 12.9 months, 51.4% and 22.2%, respectively. The patients with tumor thrombi in the main portal trunk showed statistically inferior overall survival than patients with tumor thrombi in the portal vein branches (9.8 versus 16.6 months, respectively, p = 0.036). The responders’ median survival was 13.9 months, double 6.9 months as the median survival of the non-responders. No radiation induced liver disease or treatment related mortality was not appeared.ConclusionsHypofractionated radiotherapy with HT was effective not only for tumor response but also for survival in the advanced HCC patients with PVTT. And stricter patient selection by Child-Pugh classification and JIS score may maximize the potential benefits of this treatment.

High dose radiotherapy with image-guided hypo-IMRT for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombi is more feasible and efficacious than conventional 3D-CRT

“…Yoon et al (13) observed a median survival of 10.6 months in HCC with thrombosis treated by 3D-CRT plus TACE. Recently, Kim et al (14) reported a median survival of 12.9 months in HCC with tumor thrombosis receiving hypofractionated RT, and this result is close to our data. The IG-HIMRT group in our study showed significant longer median survival than 3D-CRT patients (P = 0.005), and the 1-year survival rate was also higher (59.3 versus 35.8%).…”

Three‐dimensional conformal radiation therapy for inoperable massive hepatocellular carcinoma in six dogs

“…Recently, local liver RT has been attempted in humans, and the results suggest that local RT can be effective in controlling HCC progression (Kim et al . , Kouloulias et al . ).…”

“…Toxicity was not noted in any other dog.CLINICAL SIGNIFICANCE: 3D-CRT appears to be a viable treatment option for dogs with inoperable massive hepatocellular carcinoma.RT (3D-CRT) has enabled targeting of high-dose RT onto the tumour while simultaneously sparing the normal surrounding liver parenchyma from these high doses (Cheng et al 1999). Recently, local liver RT has been attempted in humans, and the results suggest that local RT can be effective in controlling HCC progression (Kim et al 2013, Kouloulias et al 2013. The parallel arrangement of liver-tissue functional subunits has facilitated the use of high-dose hypofractionated RT (Huang et al 2013).…”

Three-dimensional conformal radiotherapy for portal vein tumor thrombosis alone in advanced hepatocellular carcinoma

“…Recently, several investigations have attempted to deliver higher effective radiation doses at minimum field using high-precision irradiation techniques or proton beam therapy. Kim et al [ 21 ] introduced hypofractionated radiotherapy with helical tomotherapy in 35 patients with HCC including PVTT. The total radiation dose was 45-60 Gy (median, 50 Gy) in 10 fractions and capecitabine was administered concurrently during radiation.…”