Radiotherapy for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels: Efficacy and outcomes

Tanaka, Yoshiaki; Nakazawa, Takahide; Komori, Shouko; Hidaka, Hiroyoshi; Okuwaki, Yusuke; Takada, Juichi; Watanabe, Masaaki; Shibuya, Akitaka; Minamino, Tsutomu; Yamamoto, Hajime; Kokubu, Shigehiro; Hayakawa, Kazushige; Koizumi, Wasaburo

doi:10.1111/jgh.12333

Cited by 32 publications

(33 citation statements)

References 26 publications

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“…Tanaka et al suggested that RT was an effective treatment without serious adverse events for patients with HCC involving invasion to intrahepatic large vessels [26]. A previous study showed that the mOS was only 13.1 months for 2D-RT alone [27].…”

Section: Discussionmentioning

confidence: 99%

High-biologically effective dose palliative radiotherapy for a tumor thrombus might improve the long-term prognosis of hepatocellular carcinoma: a retrospective study

et al. 2017

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BackgroundThis study aimed to highlight the type of tumor thrombus and identify the prognostic factors influencing the long-term survival outcomes in patients with hepatocellular carcinoma (HCC) having a tumor thrombus. A tumor thrombus in HCC is associated with poor prognosis.MethodsEighty patients diagnosed with HCC having a tumor thrombus between May 2006 and April 2014 were enrolled in this study. Age, gender, clinical characteristics, laboratory findings, Child-Pugh classification, performance status (ECOG), types of tumor thrombi, radiotherapy method, biologically effective dose (BED), and primary treatment method were analyzed to identify the prognostic factors associated with the overall survival (OS) rates. Statistical analyses were performed using SPSS version 19.0.ResultsThe median follow-up duration was 24 months (range 6–90). The 1-, 3-, and 5-year OS rates of the patients were 77.6%, 37.6%, and 18.8%, respectively. On univariate analysis, gender, radiotherapy method, BED, types of tumor thrombi, Child-Pugh classification, ECOG, and total bilirubin were associated with OS (P < 0.001, P = 0.001, P = 0.016, P = 0.003, P < 0.001, P < 0.001, P = 0.039, respectively). The prognostic factors for OS in multi-variate analyses were gender (P < 0.001), BED (P = 0.044), Child Pugh classification (P = 0.020), performance status (ECOG) (P = 0.004), and types of tumor thrombi (P = 0.001). The median OS for the high-BED group was better than that for the low-BED groups (42 months vs. 19 months, P = 0.016).ConclusionsGender, BED, performance status (ECOG), Child-Pugh classification, and types of tumor thrombi seemed to affect OS, and a stepwise decrease in survival was observed with the types of tumor thrombi ranging from I to IV. High-BED palliative radiotherapy might improve the long-term outcomes for patients with HCC having a tumor thrombus.

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Section: Discussionmentioning

confidence: 99%

High-biologically effective dose palliative radiotherapy for a tumor thrombus might improve the long-term prognosis of hepatocellular carcinoma: a retrospective study

et al. 2017

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“…In a recent PS analysis of sorafenib alone versus sorafenib combined with TACE for advanced HCC (in which 20-30% of the patient population had major trunk PVTT), neither regimen produced a significant benefit in OS [24]. We previously reported that RT produced favorable survival benefits without the hardships associated with conventional treatment for macroscopic hepatic vascular invasion [8,17]. …”

Section: Discussionmentioning

confidence: 99%

“…Inclusion criteria for patients who received RT were as follows: (i) unresectable HCC with macroscopic hepatic vascular invasion; (ii) C-P class A or B hepatic function; (iii) an ECOG performance status of 0–2; (iv) no refractory ascites; and (v) no previous radiation therapy of the liver. The RT procedure was performed as described previously [8,17]. Briefly, macroscopic hepatic vascular invasion was mainly irradiated, regardless of the presence or absence of multinodular HCC.…”

Section: Methodsmentioning

confidence: 99%

“…We previously reported that the use of three-dimensional conformal RT (3D-CRT) resulted in a good disease control rate and prolonged survival in these patients. Because of a high induction rate of stable disease (SD), both responders and nonresponders had improved outcomes when compared with patients who received supportive care alone [8,17]. Another advantage of 3D-CRT is that treatment can be administered on an outpatient basis without the difficulties associated with TACE or hepatic infusion chemotherapy, and RT did not produce grade 3 or higher liver, gastrointestinal, or hematological toxicity [8,17].…”

Section: Introductionmentioning

confidence: 99%

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Overall survival in response to sorafenib versus radiotherapy in unresectable hepatocellular carcinoma with major portal vein tumor thrombosis: propensity score analysis

et al. 2014

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BackgroundThis study investigated the survival benefits of sorafenib vs. radiotherapy (RT) in patients with unresectable hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) in the main trunk or the first branch.MethodsNinety-seven patients were retrospectively reviewed. Forty patients were enrolled by the Kanagawa Liver Study Group and received sorafenib, and 57 consecutive patients received RT in our hospital. Overall survival was compared between the two groups with PVTT by propensity score (PS) analysis. Factors associated with survival were evaluated by multivariate analysis.ResultsThe median treatment period with sorafenib was 45 days, while the median total radiation dose was 50 Gy. The Child-Pugh class and the level of invasion into hepatic large vessels were significantly more advanced in the RT group than in the sorafenib group. Median survival did not differ significantly between the sorafenib group (4.3 months) and the RT group (5.9 months; P = 0.115). After PS matching (n = 28 per group), better survival was noted in the RT group than in the sorafenib group (median survival, 10.9 vs. 4.8 months; P = 0.025). A Cox model showed that des-γ-carboxy prothrombin <1000 mAU/mL at enrollment and RT were significant independent predictors of survival in the PS model (P = 0.024, HR, 0.508; 95% CI, 0.282 to 0.915; and P = 0.007, HR, 0.434; 95% CI, 0.235 to 0.779; respectively).ConclusionsRT is a better first-line therapy than sorafenib in patients who have advanced unresectable HCC with PVTT.

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“…These technologies can deliver maximal radiation doses to hepatic tumors without causing serious complications 15,16. Several studies have shown good local tumor control and long-term survival in HCC patients with PVTT treated using 3DCRT 17–21…”

Section: Introductionmentioning

confidence: 99%

Efficacy of three-dimensional conformal radiotherapy combined with transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus

Zhu

et al. 2016

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ObjectiveThe current study aimed to evaluate the efficacy and outcomes of three-dimensional conformal radiotherapy (3DCRT) combined with transarterial chemoembolization (TACE) for treating patients with hepatocellular carcinoma involving portal vein tumor thrombus.MethodsBetween January 2000 and December 2013, a total of 182 hepatocellular carcinoma patients with portal vein tumor thrombus were retrospectively analyzed: 68 patients were treated by 3DCRT alone (group A), 74 by TACE alone (group B), and 40 by a combination of 3DCRT + TACE (group C). The overall survival (OS) of the three groups was compared using the Kaplan–Meier method. The independent predictors of survival were identified using multivariate analysis.ResultsThe total effective rate (complete response + partial response) among all patients was 44% (80/182). The objective response rate (complete response + partial response) was higher in group C than in group A or B, but the differences were not significant. OS rates at 1, 2, and 3 years were significantly higher in group C than in group A or B (P<0.05), while OS rates were similar between groups A and B. Multivariate analysis identified serum levels of alpha-fetoprotein <400 ng/mL and the use of 3DCRT + TACE as independent predictors of better OS.ConclusionThese results suggest that combining 3DCRT with TACE may provide better OS than either technique alone in hepatocellular carcinoma patients with portal vein tumor thrombus.

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Radiotherapy for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels: Efficacy and outcomes

Abstract: RT is an effective treatment option without serious adverse events. RT should be considered for the patients with better hepatic function who have invasion to IHLVs.

Cited by 32 publications

References 26 publications

High-biologically effective dose palliative radiotherapy for a tumor thrombus might improve the long-term prognosis of hepatocellular carcinoma: a retrospective study

High-biologically effective dose palliative radiotherapy for a tumor thrombus might improve the long-term prognosis of hepatocellular carcinoma: a retrospective study

Overall survival in response to sorafenib versus radiotherapy in unresectable hepatocellular carcinoma with major portal vein tumor thrombosis: propensity score analysis

Efficacy of three-dimensional conformal radiotherapy combined with transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus

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