Three-dimensional conformal radiotherapy for portal vein tumor thrombosis alone in advanced hepatocellular carcinoma

Abstract

PurposeWe sought to evaluate the clinical outcomes of 3-dimensional conformal radiation therapy (3D-CRT) for portal vein tumor thrombosis (PVTT) alone in patients with advanced hepatocellular carcinoma.Materials and MethodsWe retrospectively analyzed data on 46 patients who received 3D-CRT for PVTT alone between June 2002 and December 2011. Response was evaluated following the Response Evaluation Criteria in Solid Tumors. Prognostic factors and 1-year survival rates were compared between responders and non-responders.ResultsThirty-seven patients (80.4%) had category B Child-Pugh scores. The Eastern Cooperative Oncology Group performance status score was 2 in 20 patients. Thirty patients (65.2%) had main or bilateral PVTT. The median irradiation dose was 50 Gy (range, 35 to 60 Gy) and the daily median dose was 2 Gy (range, 2.0 to 2.5 Gy). PVTT response was classified as complete response in 3 patients (6.5%), partial response in 12 (26.1%), stable disease in 19 (41.3%), and progressive disease in 12 (26.1%). There were 2 cases of grade 3 toxicities during or 3 months after radiotherapy. Twelve patients in the responder group (15 patients) received at least 50 Gy irradiation, but about 84% of patients in the non-responder group received less than 50 Gy. The 1-year survival rate was 66.8% in responders and 27.4% in non-responders constituting a statistically significant difference (p = 0.008).ConclusionConformal radiotherapy for PVTT alone could be chosen as a palliative treatment modality in patients with unfavorable conditions (liver, patient, or tumor factors). However, more than 50 Gy of radiation may be required.

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

“…Some studies reported response rates to prescribed BED [ 5 , 11 , 18 , 27 ]. Kim et al [ 5 ] reported that the response of PVT was higher if the prescribed BED was higher than 64 Gy 10 (50% vs. 0%).…”

“…Kim et al [ 5 ] reported that the response of PVT was higher if the prescribed BED was higher than 64 Gy 10 (50% vs. 0%). Lee et al [ 18 ] reported that the response of PVT was higher if the prescribed BED was higher than 60 Gy 10 (26.1% vs. 6.5%). Another study by Kim et al [ 11 ] also reported that the response of PVT was higher if the prescribed BED was higher than 58 Gy 10 (54.6% vs. 20%).…”

“…For example, Ishikura et al [ 28 ] used ultrasonography for the evaluation of response. But Kim et al [ 5 ], Kim et al [ 11 ], Lee et al [ 18 ], and Lin et al [ 29 ] with other studies used CT to evaluate the response of therapy. Even if the studies used same method for evaluation of response, the definition of criteria for response differed between studies.…”

“…Yet with advances in imaging, treatment planning, and treatment delivery, now we could make an attempt to deliver tumoricidal doses to target areas without incurring significant side effects [ 5 , 11 - 14 ]. Partial liver irradiation has shown some promising results in patients with unresectable HCC; promising outcomes were also observed in patients with PVT who were treated with RT [ 9 , 15 - 18 ]. The primary end point of this study was to evaluate the response of PVT or HVT treated with RT for the evaluation of the efficacy and feasibility of RT.…”

Prognostic value of pretreatment18F-FDG PET-CT in radiotherapy for patients with hepatocellular carcinoma

“…In patients who had large HCC mass with PVTT, we treated PVTT alone using TACE followed by RT. Because PVTT has limited applicability in TACE, it need to be treated with different modalities for better prognosis [ 10 ]. However, when the primary HCC was single, localized, close to PVTT, both HCC and PVTT lesions were included in GTV.…”