Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement

Tazawa, Junichi; Maeda, Manabu; Sakai, Yoshinori; Yamane, M.; Ohbayashi, Hideo; Kakinuma, Sei; Miyasaka, Yuka; Nagayama, Kazuyoshi; Enomoto, Nobuyuki; Sato, Chifumi

doi:10.1046/j.1440-1746.2001.02496.x

Cited by 99 publications

(67 citation statements)

References 18 publications

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“…10,44,45 The best survival in the current study may have been achieved by the perfect objective response of the tumors and the reserved liver function.…”

Section: Discussionmentioning

confidence: 82%

“…[42][43][44][45] The strategy in the combination therapies was that radiation was applied exclusively to treat PVTT defined as the target volume, whereas intrahepatic tumors were treated with TACE. Prior to or/and after radiation therapy, the patients underwent several courses of TACE.…”

Section: Discussionmentioning

confidence: 99%

“…6,10,11,32,33,[42][43][44][45] Furthermore, 75% of the patients in the current series had bulky tumors that measured Ն 50 mm in greatest dimension. This result suggests that proton beam therapy alone can be a curative modality of treatment for patients who have HCC with PVTT.…”

Section: Discussionmentioning

confidence: 99%

“…6,10,11,29,[31][32][33][42][43][44][45] Five of 12 patients survived for Ͼ 4 years after treatment, and, 3 patients remain alive without disease. To our knowledge, this is the first report to present excellent survival for patients who had HCC with PVTT.…”

Section: Discussionmentioning

confidence: 99%

“…There were none of the uncomfortable symptoms, such as fever or emesis, or mortal complications, such as sepsis or gastrointestinal bleeding, that were observed in the other treatment modalities (TAI, TACE, and radiation therapy with photons). 6,10,11,32,33,[42][43][44][45] In conclusion, proton beam therapy was feasible and effective for the treatment of patients who had HCC with PVTT, and it appeared to improve survival and local control significantly. A prospective study for patients with HCC who have PVTT to define the role of proton beam therapy further is proceeding at our new facility.…”

Section: Discussionmentioning

confidence: 99%

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Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Hata

Tokuuye

Sugahara

et al. 2005

Cancer

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BACKGROUNDTreatment modalities for patients with hepatocellular carcinoma (HCC) who have portal vein tumor thrombus (PVTT) are limited and controversial; furthermore, the prognosis for these patients is extremely poor. The authors conducted a retrospective review to determine the role of proton beam therapy in the treatment of patients who had HCC with PVTT.METHODSTwelve patients with HCC who had tumor thrombus in the main trunk or major branches of the portal vein (clinical T3–T4N0M0) were treated with proton beam therapy. At the time they received proton beam irradiation, patients ranged in age from 42 years to 80 years (median, 62 years), and their tumors ranged in size from 40 mm to 110 mm (median, 60 mm) in greatest dimension. A total dose of 50–72 gray (Gy) (median, 55 Gy) in 10–22 fractions was delivered to the tumors, including PVTT.RESULTSAll tumors that were treated with proton beam therapy remained controlled at a median follow‐up of 2.3 years (range, 0.3–7.3 years). Among 12 patients, 10 patients had new liver tumors outside the irradiated volume 0.1–2.4 years after proton beam therapy, and 3 patients also had distant metastases; consequently, 8 patients died of disease, and 2 patients were salvaged by further therapies. The remaining two patients were alive with no evidence of disease 4.3 years and 6.4 years after proton beam therapy. The progression‐free survival rates were 67% at 2 years and 24% at 5 years. The median progression‐free survival was 2.3 years. According to the Acute Radiation Morbidity Scoring Criteria (Radiation Therapy Oncology Group), therapy‐related toxicity ≥ Grade 3 was not observed.CONCLUSIONSProton beam therapy for patients with HCC who had PVTT was feasible and effective. It appeared to improve survival and local control significantly for these patients. Cancer 2005. © 2005 American Cancer Society.

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“…10,44,45 The best survival in the current study may have been achieved by the perfect objective response of the tumors and the reserved liver function.…”

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Hata

Tokuuye

Sugahara

et al. 2005

Cancer

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Transcatheter Arterial Chemoembolization Plus Radiotherapy Compared With Chemoembolization Alone for Hepatocellular Carcinoma

2015

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Three‐dimensional conformal radiotherapy for portal vein thrombosis of hepatocellular carcinoma

Kim

Park

Lim

et al. 2005

Cancer

169

151

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BACKGROUND Portal vein thrombosis (PVT) is a common complication in patients with advanced‐stage hepatocellular carcinoma (HCC). The authors evaluated the impact of radiotherapy (RT) for PVT of HCC and analyzed the dose‐response relation between RT and PVT. METHODS Between March 1995 and December 2003, 59 patients diagnosed as HCC with PVT were included. The inclusion criteria were unresectable tumor with thrombosis in the main or first branch of the portal vein, liver function of Child–Pugh Class A or B, and an Eastern Cooperative Oncology Group performance status score of 0–2. The median age of the patients was 57 years (range, 36–78 years). A daily dose ranging from 2 to 3 gray (Gy) was administered using 6 or 10‐megavolt (MV) X‐rays, at 5 fractions a week, to deliver a total dose range of 30–54 Gy, which was a biologic effective dose of 39–70.2 Gy10 with an α/β ratio of 10. RESULTS Follow‐up computed tomography scans showed a complete response (CR) in 4 of 59 patients (6.8%), a partial response (PR) in 23 patients (39.0%), no response (NR) in 28 patients (47.5%), and progressive disease (PD) in 4 patients (6.8%). The mean RT doses in the responders (CR and PR) and nonresponders (NR and PD) were 59.6 ± 5.6 Gy10 and 54.9 ± 8.5 Gy10, respectively (P = 0.036). The response rates in patients receiving < 58 Gy10 and ≥ 58 Gy10 were 20% and 54.6%, respectively (P = 0.034). The median survival duration and the 1‐year and 2‐year survival rates in the responders were 10.7 months, 40.7%, and 20.7%, respectively, and were 5.3 months, 25.0%, and 4.7%, respectively, in the nonresponders (P = 0.050). CONCLUSIONS RT induced a 45.8% objective response rate for PVT in patients with HCC. A dose‐response relation was found to exist between the RT dose and PVT response. These results suggested that RT may be a treatment option for PVT in patients with HCC and that an RT dose ≥ 58 Gy10 should be recommended. Cancer 2005. © 2005 American Cancer Society.

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Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement

Abstract: The combined therapy is feasible and may be useful to reverse PVTT in patients with good hepatic function reserve.

Cited by 99 publications

References 18 publications

Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Transcatheter Arterial Chemoembolization Plus Radiotherapy Compared With Chemoembolization Alone for Hepatocellular Carcinoma

Three‐dimensional conformal radiotherapy for portal vein thrombosis of hepatocellular carcinoma

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