The response of thrombosis in the portal vein or hepatic vein in hepatocellular carcinoma to radiation therapy

Abstract

PurposeThe purpose of current study is to evaluate the response of the patients with portal vein thrombosis (PVT) or hepatic vein thrombosis (HVT) in hepatocellular carcinoma (HCC) treated with three-dimensional conformal radiation therapy (3D-CRT). In addition, survival of patients and potential prognostic factors of the survival was evaluated.Materials and MethodsForty-seven patients with PVT or HVT in HCC, referred to our department for radiotherapy, were retrospectively reviewed. For 3D-CRT plans, a gross tumor volume (GTV) was defined as a hypodense filling defect area in the portal vein (PV) or hepatic vein (HV). Survival of patients, and response to radiation therapy (RT) were analyzed. Potential prognostic factors for survival and response to RT were evaluated.ResultsThe median survival time of 47 patients was 8 months, with 1-year survival rate of 15% and response rate of 40%. Changes in Child-Pugh score, response to RT, Eastern cooperative oncology group performance status (ECOG PS), hepatitis C antibody (HCVAb) positivity, and additional post RT treatment were statistically significant prognostic factors for survival in univariate analysis (p = 0.000, p = 0.018, p = 0.000, p = 0.013, and p = 0.047, respectively). Of these factors, changes in Child-Pugh score, and response to RT were significant for patients’ prognosis in multivariate analysis (p = 0.001 and p = 0.035, respectively).ConclusionRT could constitute a reasonable treatment option for patients with PVT or HVT in HCC with acceptable toxicity. Changes in Child-Pugh score, and response to RT were statistically significant factors of survival of patients.

Definitive radiation therapy for hepatocellular carcinoma with portal vein tumor thrombus

“…Initial concerns about radiation-induced liver disease (RILD) limited enthusiasm for RT in this patient population; however, as more data regarding dose-volume risk parameters become available [8] , [9] , [10] , there has been increasing interest in the use of RT for patients with locally advanced or otherwise unresectable HCC, including those with PVTT [6] , [7] , [11] . Older studies suggested a potential, though modest, survival benefit with RT for these patients [12] , [13] , [14] , [15] , [16] , [17] .…”

Treatment of hepatocellular carcinoma with portal vein tumor thrombus: advances and challenges

“…Other radiotherapy methods include proton beam therapy, intensity-modulated radiotherapy, and stereotactic radiotherapy. Using 3D-CRT to treat 47 patients with HCC and PVTT, Bae and coworkers [ 77 ] obtained a response rate of 40%, median survival time of 8 months, and 1-year survival rate of 15%. Also using 3D-CRT, Rim and coworkers [ 78 ] reported a partial response rate of 55.6%, stable disease rate of 31%, progressive disease rate of 6.7%, and complete remission rate of 6.7%.…”

Intensity-modulated radiotherapy for hepatocellular carcinoma: dosimetric and clinical results

“…Until now, we cannot determine whether the gastroduodenal toxicities developed as a consequence of RT or occurred spontaneously due to cirrhosis and PHG. Severe hematemesis by aggravation of pre-existing PHG was reported in HCC patients receiving 3DCRT regardless of radiation dose [ 48 ]. Considering that V25 or V35 of gastroduodenum were significant dosimetric parameters affecting severe gastroduodenal toxicity in two studies, the application of IMRT would reduce gastroduodenal toxicity in HCC patients by sparing the high dose regions of the gastroduodenum as mentioned above [ 45 , 47 ].…”