Abstract
Objective: To determine the possible therapeutic gain of using three-dimensional conformal radiotherapy (3D-CRT) as a treatment option for portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma (HCC) and to evaluate the tolerance and toxicity of using such treatment. Materials and methods: Sixty two patients were enrolled in this prospective study between June 2013 and August 2015. The clinical target volume (CTV) was the PVTT and the prescribed dose was 50 Gy/25 fractions. The median follow-up time was 7.4 months. Results: The thrombus crude response rate was 40.4% and the only significant prognostic factor for response was the thrombus size. Responders had significant better survival compared to non-responders with a median survival of 12.5 and 8 months respectively (P < 0.0001). The radiation toxicity profile was satisfactory. Conclusions: The results of this study suggest that radiotherapy should be considered as a safe treatment option for HCC patients with PVTT. It is effective not only for PVTT local control but also for survival, although prospective randomized trials are needed to confirm these results.
Highlights
Hepatocellular carcinoma accounts for about 80% - 90% of primary liver cancers
The results of this study suggest that radiotherapy should be considered as a safe treatment option for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT)
The exclusion criteria included: 1) Liver function of Child-Pugh class C; 2) Tumors which were occupying more than two-thirds of the Liver; 3) The presence of extra hepatic nodal or visceral metastases; 4) Patients with associated comorbidities or social factors that may interfere with radiotherapy delivery, treatment completion or follow up; 5) WHO performance status of 3 or 4; 6) Thrombus reaching Inferior Vena Cava; 7) Patients who refused to participate in this study
Summary
Hepatocellular carcinoma accounts for about 80% - 90% of primary liver cancers Worldwide it is ranked as the fifth most common cancer and the third most. According to Barcelona Clinic Liver Cancer (BCLC) guidelines patients with advanced stage disease are complicated by portal invasion but status with good performance are candidates for new antitumor agents [5]. Median survival time of those patients was reported from 6 to 13 months [7] [8] [9] Based on this background, this study was conducted to determine the possible therapeutic gain of using 3-DCRT as a treatment option for PVTT and to evaluate the tolerance and toxicity of using such treatment. The study evaluated the thrombus response to radiotherapy and tried to define the prognostic factors related to both the patient and the thrombus
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