Stereotactic body radiotherapy based treatment for hepatocellular carcinoma with extensive portal vein tumor thrombosis

Abstract

BackgroundThere is currently no worldwide consensus for the management of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). We evaluated the efficacy of stereotactic body radiotherapy (SBRT) as the initial treatment for HCC with extensive PVTT based on a relatively large number of patients.MethodsIn our multidisciplinary approach for patients with hepatobiliary tumors, SBRT is recommended for unresectable HCC with PVTT or those with contraindication for transarterial chemoembolization (TACE). The aim is to shrink the tumor thrombus and preserve adequate portal venous flow, thus facilitating subsequent treatments such as TACE and tumor resection. In the present study, 70 continuous cases of HCC patients with extensive PVTT initially treated with SBRT were studied. The median follow-up period was 9.5 months (range, 1.0–21.0 months). The dynamic changes of tumor thrombosis with time after SBRT were also analyzed.ResultsThe median survival time for the whole group was 10.0 months (95% CI, 7.7–12.3 months), with a 6- and 12-month overall survival (OS) rate of 67.3%, and 40.0% respectively. Patients who received combined SBRT and TACE showed significantly longer OS than those without indication for TACE after SBRT (12.0 ± 1.6 vs. 3.0 ± 1.0 months). Patients with good response to radiation usually had better survival. SBRT was well tolerated in our patient series.ConclusionsIn conclusion, SBRT used as the initial treatment for HCC patients with extensive PVTT originally unsuitable for resection or TACE can achieve adequate thrombus shrinkage and portal vein flow restoration in the majority of cases. It could thus offer the patients an opportunity to undergo further treatment such as resection or TACE procedure. Such therapeutic strategy may result in survival advantage, especially for those who do receive combined modality with SBRT.

Stereotactic Body Radiotherapy Combined with Transcatheter Arterial Chemoembolization versus Stereotactic Body Radiotherapy Alone as the First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review

“…The results suggested that the ST group had a longer OS than the SA group. Shui et al [23] also reported that the ST group had a longer OS than the SA group (12.0 ± 1.6 vs. 3.0 ± 1.0 months, p < 0.001). Su et al [14] evaluated the long-term survival of the ST group and SA group in patients with large tumor sizes (> 5 cm), with a median tumor size of 8.5 cm.…”

“…Cai et al [13] showed that the combination of TACE and SBRT can avoid the limitations encountered when using TACE or SBRT alone and achieve a good ORR of 64%, which was significantly better than that of TACE alone (41.3%) or SBRT alone (33.3%). Shui et al [23] reported that the CR rate ranged from 9.7% at 3 months to 32.2% at 6 months after SBRT; the CR rate increased with time, and they found that most PD occurred within the first 3 months. A higher rate of CR and higher DCR may enhance the OS in the ST group.…”

Stereotactic Body Radiotherapy for Hepatocellular Carcinoma: Current Evidence and the Feasibility of Radiomics-based Predictive Models

“…Nonetheless, SBRT is still considered to be of therapeutic benefit for patients with PVT [31]. In the evaluable 53 cases of PVT, EndR was achieved in 42 cases (79.2%), which represented a higher percentage than in patients who received Sorafenib alone (7% based on mRECIST) in a comparable study [32].…”

Efficacy and safety of stereotactic body radiation therapy combined with transarterial chemoembolization for Chinese intermediate-to advanced-stage hepatocellular carcinoma patients: a systematic review and meta-analysis

“…As a result, in spite of the rapid development of radiotherapy for HCC, the efficacy was not significantly improved. In recent years, with the growth of stereotactic radiotherapy, SBRT is gradually appropriate for intermediate-to advanced-HCC [19][20][21][22] . SBRT delivers a high dose of radiation to HCC within a short period time and is effective and less invasive for the delivery of high radiation doses to the tumor with hypofractionation.…”