Potential Prognostic Benefits of Radiotherapy as an Initial Treatment for Patients with Unresectable Advanced Hepatocellular Carcinoma with Invasion to Intrahepatic Large Vessels

Abstract

Objectives: To examine the efficacy and prognostic benefits of radiotherapy (RT) in patients who have unresectable advanced hepatocellular carcinoma (HCC) with invasion to intrahepatic large vessels (IHLVs). Methods: Sixty-eight patients who had advanced HCC with invasion to IHLVs were studied. Thirty-two consecutive patients initially received 3-dimensional conformal RT for HCC invasion to IHLVs. Tumor response, prognostic factors, and survival were studied in the patients given RT. Prognostic factors and survival were assessed in the study group as a whole. Data were analyzed using the Kaplan-Meier method, univariate analysis, and a Cox model. Results: The rate of objective response to RT was 48%. Predictors of survival in the patients who received RT were a hepatic function of Child-Pugh class A (p = 0.0263) and a response to RT (p = 0.0121). In the study group as a whole, independent predictors of survival in a Cox model were multinodular HCC (p = 0.007), inferior vena caval invasion (p = 0.001), a serum α-fetoprotein level of >1,000 ng/ml (p = 0.032), and the performance of RT (p < 0.001). Notably, the median survival of the nonresponders to RT (n = 15) was significantly longer than that of the patients who received no treatment for HCC (n = 21; 7.0 vs. 3.4 months, p = 0.0014). Conclusion: RT is considered an effective initial treatment for HCC invasion to IHLVs, and may offer survival benefits, even in nonresponders, because of the induction of stable disease.

Multimodality Treatment with Radiotherapy for Huge Hepatocellular Carcinoma

“…According to the multivariate analysis, we showed that the initial tumor characteristics and the treatment response were important factors in the clinical outcome, which is consistent with the results of previous studies [6,29,30,31]. Particularly, patients who survived >2 years tended to have good prognostic factors, including a low UICC stage, the absence of PVTT, a low number of tumors, hepatic resection, and a favorable tumor response.…”

Sunitinib combined with transarterial chemoembolization versus transarterial chemoembolization alone for advanced-stage hepatocellular carcinoma: a propensity score matching study

“…Advanced HCC sometimes causes macroscopic hepatic vascular invasion, including portal vein tumor thrombosis in the main portal trunk or the first branch and venous thrombosis in the hepatic vein trunk or inferior vena cava. These conditions can be life threatening, and the prognosis of patients with portal vein tumor thrombosis remains very poor, with a median survival of only approximately 3 months without treatment [26,27]. The survival advantage of combined TACE and sorafenib seen in our study was more remarkable for difficult-to-treat HCCs with aggressive biologic behavior such as vascular invasion, distant organ metastasis, and high serum AFP level.…”

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.…”

“…HCC with IVCTT has an extremely poor prognosis. Nakazawa et al reported that the median survival of HCC with Vv2 and Vv3 invasion was 1.5 months among patients who received no treatment [9]; however, a standard treatment strategy has not been established. Ablation therapies such as percutaneous ethanol injection and radiofrequency ablation appear unsuitable for the treatment of IVCTT.…”

“…HCC with IVCTT may be complicated by lung metastasis, pulmonary infarction, secondary Budd-Chiari syndrome, ball-valve thrombus syndrome, and heart failure. 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].…”