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

Abstract

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.

Sorafenib therapy following resection prolongs disease-free survival in patients with advanced hepatocellular carcinoma at a high risk of recurrence

“…Although TACE appears to have potential for providing a survival benefit for HCC patients with PVTT, with a median PFS of 3.6-5.1 months (54,55), the deteriorating liver function caused by TACE limits its application (56,57). By contrast, hepatic resection may produce superior survival benefits for HCC patients with PVTT, with a 1-year overall survival rate of 34.4-42.0% (58)(59)(60)(61), and radiotherapy may have superior local effects in these patients (62,63). The prognosis of HCC patients with PVTT is dismal.…”

“…Shi et al demonstrated that liver resection with portal thrombectomy for HCC cases with PVTT, compared with resection without portal thrombectomy, is justified in selected patients with PVTT located in the segmental or sectoral branches of the portal vein (61). Zhang et al suggested that percutaneous transhepatic portal vein stenting (PTPVS)-TACE combined with three-dimensional conformal radiotherapy (3-DCRT), compared with PTPVS-TACE without 3-DCRT, is possibly an effective treatment modality for HCC with PVTT (63).Kim et al noticed that radiotherapy induced a 45.8% objective response rate for PVTT in patients with HCC, and considered that radiotherapy may be a treatment option for PVTT in patients with HCC (62).…”

The retrospective cohort study for survival rate in patients with advanced hepatocellular carcinoma receiving radiotherapy or palliative care

“…11,13,25 Meanwhile, the combination of TACE and local radiotherapy has been applied continuously to primary HCC which cannot be resected, and its positive outcomes of enhancing the survival rate have been reported. 12,30 In particular, antitumor agents, which were used during TACE to tumor cells on the tumor margin, work as radiosensitizers not only to increase the effect of radiotherapy but also to make TACE available by improving portal vein thrombosis.…”

“…8 Providing a high-dose irradiation as a local irradiation, not the whole liver irradiation, has been identified, which has been continuously reported that the combination therapy of radiotherapy and chemotherapy or TACE for HCC works favorably. [9][10][11] What is more, in case of the patients who are not under other treatments or associating with portal vein thrombosis, [12][13][14][15] radiotherapy was safe and effective to raise the survival rate. 16 The radiotherapy had the effect of relieving cancer pain, improving symptoms through the decrease of lesions, lengthening the survival time in the circumstances with the biliary obstruction of a tumor associated with jaundice, 17,18 and extending the survival time in patients with abdominal lymph node metastasis.…”

Stereotactic body radiation therapy: A novel treatment modality for inoperable hepatocellular carcinoma

“…The rational for this approach is that RT targets cancer cells at the tumors periphery that may remain viable through blood supply from collateral circulation or recanalization of the embolized artery (51). The third approach, tumor shrinkage after TACE allows the use of smaller irradiation fields, which permits higher tumor doses and improves normal liver tolerance (52). Furthermore, the TACE anticancer drugs retained in the tumor may have a radiosensitizing effect (53,54).…”