Stereotactic ablative radiotherapy versus conventionally fractionated radiotherapy in the treatment of hepatocellular carcinoma with portal vein invasion: a retrospective analysis

Abstract

BackgroundThis study aimed to compare the clinical outcomes of stereotactic ablative radiotherapy (SABR) and conventionally fractionated radiotherapy (CFRT) in hepatocellular carcinoma (HCC) patients with portal vein invasion (PVI).MethodsHCC patients with PVI treated with radiotherapy from 2007 to 2016 were analysed. CFRT was administered at a median dose of 51.5 Gy (interquartile range, 45–54 Gy) with 1.8–3 Gy per fraction. SABR was administered at a median dose of 45 Gy (interquartile range, 40–48 Gy) with 6–12.5 Gy per fraction. Treatment efficacy, toxicity, and associated predictors were assessed.ResultsAmong the 104 evaluable patients (45 in the SABR group and 59 in the CFRT group), the overall response rate (ORR, complete and partial response) was significantly higher in the SABR group than the CFRT group (62.2% vs. 33.8%, p = 0.003). The 1-year overall survival (OS) rate (34.9% vs. 15.3%, p = 0.012) and in-field progression-free survival (IFPS) rate (69.6% vs. 32.2%, p = 0.007) were also significantly higher in the SABR vs. CFRT group. All 3 rates remained higher in the SABR group after propensity score matching. Multivariable analysis identified SABR and a biologically effective dose ≥65 Gy as favourable predicators of OS. There was no difference between treatment groups in the incidence of radiation-induced liver disease or increase of Child-Pugh score ≥ 2 within 3 months of radiotherapy.ConclusionsSABR was superior to CFRT in terms of ORR, OS, and IFPS. We suggest that SABR should be the preferred technique for HCC patients with PVI.

Stereotactic body radiotherapy versus intensity-modulated radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis

“…Our results in both groups compared favorably to the published literatures [12][13][14][15][16][17][18][19][20][21] (Table 2). The comparability of PFS and OS in our study may be because the therapeutic effect is actually the same, and not the arti cial result of particularly poor or excellent IMRT and SBRT procedures.…”

“…Similarly, Rim et al [22] reported a comparable 1-year OS between 3-dimensional conformal RT and SBRT (48.5% vs 46.5%). Yang et al [18] also showed a considerable survival bene t in SBRT compared to RT (1-and 2-year OS: 33.1% and 16.5% vs. 17.3% and 5.2%) in 140 patients with advanced HCC with PVTT. Consequently, it is plausible that SBRT is feasible for patients with PVTT, with acceptable toxicity and survival outcomes.…”

Predictive factors for survival following stereotactic body radiotherapy for hepatocellular carcinoma with portal vein tumour thrombosis and construction of a nomogram

“…Currently, SBRT has been used in the treatment of HCC with PVTT [ 16 , 17 ]. To shrink the tumour thrombus and maintain sufficient portal venous flow, SBRT is recommended for patients with unresectable HCC having PVTT and for those with contraindications for TACE [ 18 , 19 ]. Despite the existence of clinical reports on the efficacy and safety of SBRT for HCC with PVTT, to the best of our knowledge, there is no nomogram for predicting survival of patients with HCC and PVTT after undergoing SBRT.…”

Ablative radiation therapy for hepatocellular carcinoma is associated with reduced treatment- and tumor-related liver failure and improved survival

“…Their reported survival rate is lower than the 1-year OS of around 66% for our subgroup of patients treated with BED ≥80 Gy. However, of note is that they used a lower BED and all of their patients had tumor vascular thrombosis, which may have contributed to inferior outcomes (17).…”