Neoadjuvant radiotherapy for resectable hepatocellular carcinoma with portal vein tumor thrombus: a systematic review

Wei, Zhewen; Zhao, Jianjun; Bi, Xinyu; Zhang, Yefan; Zhou, Jianguo; Li, Zhiyu; Huang, Zhen; Zhao, Hong; Cai, Jianqiang

doi:10.21037/hbsn-20-854

Cited by 13 publications

(6 citation statements)

References 35 publications

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“…The most recent Barcelona Clinic Liver Cancer (BCLC) staging system strategy recommends systemic therapy based on atezolizumab plus bevacizumab as the first-line treatment for patients with HCC manifesting PVTT, who were classified as being in the advanced stage, and in recent clinical trials, expected to have a median survival rate of over 2 years, approximately [ 3 ]. However, in several recently published studies, surgical resection has been shown to have better survival outcomes in selected patients than in the non-liver resection group or other treatment modalities, including systemic therapy or TACE [ 6 , 14 - 17 ]. In the present study, the expected median OS and RFS after surgical resection for patients with HCC and PVTT was 32.4 and 8.6 months, respectively.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcome and risk scoring to predict survival after hepatic resection for hepatocellular carcinoma with portal vein tumor thrombosis

Kim,

Yang,

Choi

et al. 2024

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims The hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is classified as the advanced stage (BCLC stage C) with extremely poor prognosis, and in current guidelines is recommended for systemic therapy. This study aimed to evaluate the surgical outcomes and long-term prognosis after hepatic resection (HR) for patients who have HCC combined with PVTT. Methods We retrospectively analyzed 332 patients who underwent HR for HCC with PVTT at ten tertiary referral hospitals in South Korea. Results The median overall and recurrence-free survival after HR were 32.4 and 8.6 months, while the 1-, 3-, and 5-year overall survival rates were 75%, 48%, and 39%, respectively. In multivariate analysis, tumor number, tumor size, AFP, PIVKA−II, neutrophil-to-lymphocyte ratio, and albumin–bilirubin (ALBI) grade were significant prognostic factors. The risk scoring was developed using these seven factors–tumor, inflammation and hepatic function (TIF), to predict patient prognosis. The prognosis of the patients was well stratified according to the scores (log-rank test, p < 0.001). Conclusions HR for patients who have HCC combined with PVTT provided favorable survival outcomes. The risk scoring was useful in predicting prognosis, and determining the appropriate treatment strategy for those patients who have HCC with PVTT.

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Section: Discussionmentioning

confidence: 99%

Surgical outcome and risk scoring to predict survival after hepatic resection for hepatocellular carcinoma with portal vein tumor thrombosis

Kim,

Yang,

Choi

et al. 2024

Ann Hepatobiliary Pancreat Surg

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“…Systemic chemotherapy, EBRT, or a combination of both are preferred. 32 , 33 A recent study concluded that combined TACE and radiation therapy (RT), rather than systemic treatment alone, may be considered as a first-line treatment option for patients with HCC and macrovascular invasion. 34 A previous randomized controlled trial and systematic review reported that neoadjuvant RT provided significantly better post-operative survival outcomes than surgery alone in patients with resectable HCC and PVTT.…”

Section: Discussionmentioning

confidence: 99%

“…Our study also demonstrated that even in patients with resectable Vp3 or Vp4 HCC PVTT, scheduled hepatectomy improved OS when combined with TACE and EBRT as neoadjuvant therapy. 32,35 Our study revealed that preoperative TACE and EBRT might effectively prevent tumor spread and influence the decision to perform surgical LR. Although the difference between the two groups was insignificant and small, it indicates the possibility of a good prognosis (Fig.…”

mentioning

confidence: 87%

Liver resection in selective hepatocellular carcinoma with Vp3 or Vp4 portal vein tumor thrombosis improves prognosis

Lim,

Kim,

Rhu

et al. 2024

JLC

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Background/Aim: Hepatocellular carcinoma (HCC) tumor thrombi located in the first branch of the portal vein (Vp3) or in the main portal trunk (Vp4) are associated with poor prognosis. This study aimed to investigate the clinicopathological characteristics and risk factors for HCC recurrence and mortality following liver resection (LR) in patients with Vp3 or Vp4 HCC.Methods: The study included 64 patients who underwent LR for HCC with Vp3 or Vp4 portal vein tumor thrombosis (PVTT).Results: Fifty-eight patients (90.6%) had Vp3 PVTT, whereas the remaining six patients exhibited Vp4 PVTT. The median tumor size measured 8 cm, with approximately 36% of patients presented with multiple tumors. Fifty-four patients (84.4%) underwent open LR, whereas 10 patients underwent laparoscopic LR. In the Vp4 cases, combined LR and tumor thrombectomy were performed. The 3-year cumulative disease-free survival rate was 42.8% for the Vp3 group and 22.2% for the Vp4 group. The overall survival (OS) rate at 3 years was 47.9% for the Vp3 group and 60.0% for the Vp4 group. Intrahepatic metastasis has been identified as an important contributor to HCC recurrence. High hemoglobin levels are associated with high mortality.Conclusion: LR is a safe and effective treatment modality for selected patients with Vp3 or Vp4 HCC PVTT. This suggests that LR is a viable option for these patients, with favorable outcomes in terms of OS.

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“…By inducing tumour necrosis and shrinkage, neoadjuvant RT may be able to eradicate or inhibit the number and extent of MVI, resulting in decrease in recurrence rate. Neoadjuvant RT has been shown in several studies in inducing HCC shrinkage with good safety 8 , 9 , 29 , 30 . In our previous studies on neoadjuvant RT for HCC with major portal vein tumour thrombus, the objective response rates of RT using a daily fractional dose of 3 Gy in 6 consecutive days ranged from 20.7 to 24.0% 8 , 9 .…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant intensity modulated radiotherapy for a single and small (≤5 cm) hepatitis B virus-related hepatocellular carcinoma predicted to have high risks of microvascular invasion: a randomized clinical trial

Wei¹,

Jiang²,

Feng³

et al. 2023

International Journal of Surgery

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Background: The presence of microvascular invasion (MVI) significantly impairs postoperative long-term survival of patients with hepatocellular carcinoma (HCC). The role of neoadjuvant radiotherapy (RT) in treating patients with an early-stage HCC predicted to have high risks of MVI remains to be explored. Materials and methods: Consecutive patients with a resectable single and small (≤5 cm) hepatitis B virus-related HCC predicted to have high risks of MVI were randomized 1:1 to receive either neoadjuvant intensity modulated radiation therapy (18 Gy with fractionated doses of 3 Gy) followed by surgery 4 weeks later or upfront surgery. The primary endpoint was disease-free survival (DFS). The secondary outcomes included overall survival (OS), objective response rate, RT-related toxicity and surgical complications. Results: There were 30 patients randomized to each of the two groups. In the neoadjuvant RT group, three patients violated the study protocol, with two having upfront hepatectomy and one radiofrequency ablation after RT. The objective response rate after RT was 25.0% (7/28), but 2 patients suffered from grade 3 liver toxicity. The median follow-up was 68 months (interquartile range, 58–70 months) in the neoadjuvant RT group, and 68 months (interquartile range, 62–75 months) in the upfront surgery group. On intention-to-treat analysis, the median DFS and median OS were not reached in both the 2 arms. The 1-year, 2-year, 3-year and 5-year DFS rates for the neoadjuvant RT group were 86.7%, 76.7%, 60.0% and 56.3%, versus 90.0%, 66.7%, 52.8% and 45.7% in the upfront surgery group (P=0.448), respectively. The corresponding OS rates were 96.7%, 86.7%, 83.3% and 72.7%, versus 100.0%, 93.3%, 79.6% and 60.7% (P = 0.399). Conclusion and relevance: For patients with a resectable single and small hepatitis B virus-related HCC predicted to have high risks of MVI, neoadjuvant RT gave a promising response rate with a mild toxicity. Nevertheless, the neoadjuvant RT yielded similar long-term DFS and OS rates compared with patients who underwent upfront surgery.

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Neoadjuvant radiotherapy for resectable hepatocellular carcinoma with portal vein tumor thrombus: a systematic review

Abstract: Importance: The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is extremely poor. The clinical outcome of preoperative radiotherapy (RT) is still controversial.

Cited by 13 publications

References 35 publications

Surgical outcome and risk scoring to predict survival after hepatic resection for hepatocellular carcinoma with portal vein tumor thrombosis

Surgical outcome and risk scoring to predict survival after hepatic resection for hepatocellular carcinoma with portal vein tumor thrombosis

Liver resection in selective hepatocellular carcinoma with Vp3 or Vp4 portal vein tumor thrombosis improves prognosis

Neoadjuvant intensity modulated radiotherapy for a single and small (≤5 cm) hepatitis B virus-related hepatocellular carcinoma predicted to have high risks of microvascular invasion: a randomized clinical trial

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