Radiation Therapy for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Abstract

Purpose: To evaluate the effectiveness of radiation therapy (RT) for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) and to analyze the prognostic factors. Materials and Methods: From December 2004 to April 2009, 70 patients who had HCC with PVTT were treated with RT at Keimyung University Dongsan Medical Center. Nineteen patients whose total dose was below 30 Gy and one patient who underwent liver transplantation were excluded. The remaining 50 patients (45 males, 5 females; median age 55 years) were analyzed. According to the LCSGJ TNM stage, there were 27 patients (54.0%) with stage III and 23 (46.0%) with stage IV. Total dose of 30∼54 Gy was administered (median 45). Thirty patients (60.0%) were treated with concurrent chemoradiation therapy (CCRT). The median follow-up duration was from 13.5 months (range, 3 to 70 months). Results: The median survival time from the start of RT was 9 months. One-year and 2-year overall survival rates were 24.9% and 11.2%, respectively. At the follow-up time, three patients (6.0%) displayed no evidence of disease. Seven patients (14.0%) were alive with disease, and 40 (80.0%) patients had expired due to disease progression. CCRT was associated with worse survival than RT alone (p=0.034). Response to RT (p=0.037), CLIP stage (p=0.017), and TNM stage (p=0.041) were statistically significant prognostic factors. There was no radiation-induced liver disease. Conclusion: RT is an effective and safe modality for HCC with PVTT. Further studies such as prospective randomized trials are needed to confirm the role of RT for HCC with PVTT.

Transcatheter arterial chemoembolization and radiation therapy for treatment-naïve patients with locally advanced hepatocellular carcinoma

“…Although randomized trials are lacking, several studies have reported the efficacy of combined treatment with TACE and RT in patients with advanced HCC [ 7 , 8 , 9 , 14 , 15 , 16 , 17 , 18 ]. A response rate of 25% to 76% and a median survival of 5.3 to 20 months have been reported.…”

“…Although several institutions have reported favorable outcomes with this combined treatment approach [ 7 , 8 , 9 , 14 , 15 , 16 , 17 , 18 ], interpreting the results of these studies is controversial due to heterogeneity in study populations, histories of prior treatments, and the strategies used to combine TACE and RT. The purpose of this study was to evaluate the efficacy of combined TACE followed 2 weeks later by RT among treatment-naïve patients with BCLC stage C of which prognosis was validated in several studies [ 19 , 20 ] to limit potential confounding effects by prior treatments for HCC and heterogeneity of study population.…”