Overall response of both intrahepatic tumor and portal vein tumor thrombosis is a good prognostic factor for hepatocellular carcinoma patients receiving concurrent chemoradiotherapy

Abstract

This study investigated the prognostic significance of portal vein tumor thrombosis (PVTT) response in hepatocellular carcinoma (HCC) patients treated with localized concurrent chemoradiotherapy (CCRT). We retrospectively analyzed 100 patients treated with CCRT for UICC Stage T2–4N0M0 HCC with PVTT between 2002 and 2011. The radiotherapy (RT) volume included both primary tumor and PVTT, and the median radiation dose was 45 Gy. Treatment response was evaluated for up to 6 months after RT. With respect to PVTT response to treatment, complete response (CR) and partial response (PR) were achieved in 14% and 48% of patients, respectively, yielding an objective response (OR) rate of 62%. PVTT size (≤3cm diameter) was associated with a higher rate of a CR (P = 0.001). The median overall survival (OS) was 11.6 months. Independent prognostic factors for OS were OR of the tumor to RT and a CR of the PVTT. Achieving an OR in both the tumor and the PVTT demonstrated a significant correlation with improved survival (P = 0.002). Progression of intrahepatic metastasis was affected not by CCRT but by the clinical features of the PVTT, particularly the initial PVTT site. PVTT response following CCRT seems prognostically significant. CR of the PVTT was associated with improved survival. Achieving an OR in both the tumor and PVTT was also associated with improved survival.

Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area

“…Although radiotherapy (RT) is not recognized as the standard of care because of lack of controlled phase III trials, numerous studies have demonstrated that RT not only causes tumour responses but also provides prolonged survival in this group. Significant responses after RT in patients with HCC and PVTT have been reported, and the objective response rate of PVTT was 39–62% . In several reports, the RT responder group showed significantly longer survival than the non‐responders , and the response to RT was an independent prognostic factor associated with better survival in multivariate analysis .…”

Thermosensitive Hydrogel Co-loaded with Gold Nanoparticles and Doxorubicin for Effective Chemoradiotherapy

“…Notably, the sensitive effect was less evident in HepG2 cells under 4 or 6 Gy radiation. These could be explained by the different radiosensitivities of different cells and by the different cellular uptake rates of AuNPs on different cells (48.5% for B16, 28.9% for HepG2 at 24 h) (4,29,39). Previous studies on cell viability were mostly carried out with X-ray dose constant or changed without a gradation (38).…”

Optimal Selection of Radiotherapy as Part of a Multimodal Approach for Hepatocellular Carcinoma

“…However, PVTT is sensitive to RT, and the response rate ranges from 25% to 61.5% [52,[55][56][57][58]. Furthermore, RT can boost the treatment responses of tumors and PVTT, and thus likely bestows a survival benefit [33,52,[59][60][61][62]. In one retrospective study, preoperative RT induced PVTT necrosis in 8 patients (53.3%), and preoperative RT followed by surgery resulted in better outcomes than surgery alone for HCC with PVTT (5-year survival rate: 34.8% vs. 13.1%, p=0.0359) [61].…”