INTRABEAM intraoperative radiotherapy combined with portal vein infusion chemotherapy for treating hepatocellular carcinoma with portal vein tumor thrombus

Abstract

Background: Portal vein tumor thrombus (PVTT) is common in hepatocellular carcinoma (HCC). Recent studies indicate that more aggressive treatments, including surgical resection or locoregional treatment, may benefit selected HCC patients with PVTT. External radiation therapy and infusion chemotherapy were found to achieve good outcomes; however, the use of low-energy x-ray radiation system (INTRABEAM), intraoperative radiation therapy, and portal vein infusion chemotherapy for PVTT has not been reported. Case summary: We present a case of HCC with PVTT. The patient underwent hemihepatectomy and thrombectomy along with intraoperative radiotherapy (IORT) using a portable INTRABEAM radiation system. Subsequently, to treat PVTT, portal vein infusion chemotherapy with FOLFOX (leucovorin [Folinic acid], fluorouracil, and oxaliplatin) regimen was administered. There were no obvious post-operative complications. After 20 months follow-up period, no obvious tumor recurrence had been observed, and PVTT gradually disappeared completely. Conclusions: IORT using the INTRABEAM radiation system combined with portal vein infusion chemotherapy is promising for select patients with PVTT.

Tumor multifocality and serum albumin levels can identify groups of patients with hepatocellular carcinoma and portal vein thrombosis having distinct survival outcomes

“… Kaplan-Meier Analysis Univariate Cox regression N Median Survival time (months) (95% C.I.) Log-Rank p-value HR ∗ (95% CI) HR p-value Combination Nodule # & serum Albumin (g/dL) # Nodules (≤2) & Albumin (≥3.5) a 312 17 mo [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] ]. <0.0001 Reference # Nodules (≤2) & Albumin (<3.5) b 477 8 mo [ [7] , [8] , [9] ].…”

“… (95% C.I.) Log-Rank p-value HR ∗ (95% CI) HR p-value Combination Nodule # & serum Albumin (g/dL) Nodule # (≤2) & Albumin (≥3.5) a 139 21 mo [ [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ]. <0.0001 Reference Nodule # (≤2) & Albumin (<3.5) b 186 9 mo [ [8] , [9] , [10] , [11] , [12] , [13] ].…”

“… <0.0001 Reference Nodule # (≤2) & Albumin (<3.5) b 186 9 mo [ [8] , [9] , [10] , [11] , [12] , [13] ]. 1.56 (1.20–2.02) 0.001 Nodule # (>2) & Albumin (≥3.5) b 50 12 mo [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ]. 1.48 (1.02–2.15) 0.04 Nodule # (>2) & Albumin (<3.5) c 73 5 mo [ [4] , [5] , [6] , [7] ].…”

“…However, multiple reports suggest that resection for HCC patients with PVT has a survival advantage [ 16 , 17 ], although it is not clear that liver transplantation does, except a very recent report concerning treatment of PVT patients with neo-adjuvant stereotactic body radiotherapy (SBRT) prior to liver transplant, which seems to confer a survival benefit [ 18 ]. In this context, other reports have begun to show responses of the PVT to various forms of radiation and possibly also with associated survival benefits [ [19] , [20] , [21] ]. Additionally, chemoembolization of HCC patients with PVT who have a tumor response has also been reported to be associated with a survival advantage [ 22 ].…”