Abstract
BackgroundInformation about radiation-induced liver disease (RILD) in hepatocellular carcinoma (HCC) patients preexisting hepatitis B cirrhosis with portal vein tumor thrombus (PVTT) extended to the main portal vein treated with stereotactic body radiotherapy (SBRT) is still inadequate and the predictive markers for RILD have not been cleared in these patients. The aim of the study is to identify factors that can be used to predict RILD and to evaluate the influence of RILD in these patients.MethodsIn our study, 59 patients were analyzed and evaluated from December 2015 to June 2019, according to the entry criteria. After treatment, 59 patients were followed up within the first month and then every 3 months. Hematology test, tumor markers, three-phasic CT scan of the lungs, and CT or MRI scan of the liver were performed at each follow up.ResultsMedian overall survival time was 10.7 months (range, 5.8 to 14.9). RILD appeared in 17 of the 59 patients (28.8%) at the 3rd month after SBRT. In the univariate analysis, not only the CP score class (A or B) but also each different pretreatment CP score (p < 0.05) was a significant predictive factor of RILD. More RILD cases were detected with the increase of CP score. The recovery rate decreased as the baseline CP score increased (p < 0.05). It was found that the overall survival time was affected by only baseline CP score and RILD (p < 0.05).ConclusionsThe development of RILD has a dependency on the CP score in these patients. CP scores before treatment and RILD are significantly associated with overall survival. SBRT is an effective and safe method for patients with CP ≤ B7. For patients with CP-B8, liver function should be monitored more frequently. It is not safe enough for the SBRT treatment in CP-B9 patients.
Highlights
Hepatocellular carcinoma (HCC) is a kind of tumor with very high malignancy
For patients with low CP scores and without radiation-induced liver disease (RILD), the survival time is longer (CP-A6: hazard ratio (HR), 0.003; 95% confidence interval (CI), 0.000 to 0.107; p = 0.001) (CP-B7: HR, 0.009; 95% CI, 0.000 to 0.208; p = 0.003) (CP-B8: HR, 0.023; 95% CI, 0.001 to 0.372; p = 0.008) (CP-B9: HR, 0.094; 95% CI, 0.004 to 0.645; p = 0.022) (RILD: HR, 1.007; 95% CI, 0.347 to 2.880; p = 0.04) (Figure 3 and Table 6)
Previous studies have shown that when the cancer thrombus existed in the main portal vein, the median survival time was only 5.6 months, especially in patients with liver function grade B, whose median survival time was less than 3 months [20]
Summary
Hepatocellular carcinoma (HCC) is a kind of tumor with very high malignancy. The incidence of HCC ranked 6th among all types of cancer worldwide. The most common form of MVI in HCC is portal vein tumor thrombus (PVTT), patients with which have a very short survival time, with an incidence ranging from 44 to 62.2%, and the prognosis for patients with PVTT remains poor till [5]. Patients with PVTT presented in the main or contralateral branch of portal vein had no survival benefits from surgical resection, whose survival times were generally even shorter [6]. Information about radiation-induced liver disease (RILD) in hepatocellular carcinoma (HCC) patients preexisting hepatitis B cirrhosis with portal vein tumor thrombus (PVTT) extended to the main portal vein treated with stereotactic body radiotherapy (SBRT) is still inadequate and the predictive markers for RILD have not been cleared in these patients. The aim of the study is to identify factors that can be used to predict RILD and to evaluate the influence of RILD in these patients
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