Combination treatment of transcatheter arterial chemoembolization, intensity-modulated radiotherapy, and sorafenib for hepatocellular carcinoma with macrovascular invasion.

Abstract

This study evaluated the therapeutic effects and toxic reactions of combining transcatheter arterial chemoembolization (TACE) and intensity-modulated radiotherapy (IMRT) with sorafenib for the treatment of advanced hepatocellular carcinoma (HCC) patients with macrovascular invasion (MVI). We retrospectively analyzed the clinical data of 82 HCC patients with MVI, among whom 35 were treated with TACE plus IMRT alone, and 47 were treated with the combined therapy of TACE, IMRT, and sorafenib. The progression-free survival (PFS), overall survival (OS), and adverse events were assessed. The baseline characteristics were comparable between the 2 groups (all P > .05). In the TACE plus IMRT plus sorafenib group, the median PFS was 17.2 months (95% confidence interval, 14.1-19.9), significantly longer than the 9.4 months (95% confidence interval, 6.8-11.2) observed in the TACE plus IMRT group (P < .001). Additionally, patients treated with the TACE plus IMRT plus sorafenib showed a longer median OS than those treated with TACE plus IMRT alone (24.1 vs 17.3 months; P < .001). The occurrence rates of grade 1 to 2 hand-foot syndrome, other skin reactions, diarrhea, and hair loss were higher in the TACE plus IMRT plus sorafenib group (all P < .05). There were no grade 4 or higher adverse events in either group. The combination of TACE plus IMRT with sorafenib provided substantial clinical benefits in the treatment of HCC patients with MVI, increasing the tumor response rate and prolonging both PFS and OS. This approach demonstrated a tolerable and manageable safety profile.