Abstract
BackgroundHepatocellular carcinoma (HCC) with inferior vena cava (IVC) involvement is a rare disease with poor prognosis. This study aimed to evaluate the outcome of HCC patients receiving radiotherapy (RT) to IVC tumor thrombus.MethodsA total of 42 consecutive HCC patients treated with RT to IVC tumor thrombus between September 2007 and October 2018 were enrolled. Overall survival (OS), the response of IVC thrombus, prognostic factors and failure pattern were assessed.ResultsThe median follow-up time was 4.4 months. The median RT equivalent dose in 2-Gy fractions was 48.75 Gy (range, 3.25–67.10). The objective response rate of IVC thrombus was 47.6% (95% confidence interval [CI], 33.3–64.3%). The OS rate at 1 year was 30.0%, with a median OS of 6.6 months (95% CI, 3.7–9.5) from the start of RT. On multivariate analysis, Child-Pugh class, lymph node metastasis, lung metastasis and objective response of IVC thrombus were independent predictors for OS. Lung was the most common site of first progression in 14 (33.3%) patients. For 32 patients without lung metastasis before RT, use of systemic treatment concurrent with and/or after RT was associated with a significantly longer lung metastasis-free survival (5.9 vs. 1.5 months, p = 0.0033).ConclusionsRT is effective for IVC tumor thrombus of HCC with acceptable adverse effects. RT might be a treatment option incorporated into combination therapy for HCC involving IVC.
Highlights
Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the third ranked cause of global cancer mortality [1]
Before RT to inferior vena cava (IVC) thrombus, ten patients were treated by surgery, 19 by transarterial chemoembolization (TACE)/Transarterial embolization (TAE), and 11 by radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI)
A multivariable analysis of patient characteristics demonstrated that Child-Pugh class (CPC) B/C, lymph node (LN) metastasis, lung metastasis and the absence of objective response of IVC thrombus were associated with poorer overall survival (OS)
Summary
Hepatocellular carcinoma (HCC) is the most common type of liver cancer and the third ranked cause of global cancer mortality [1]. Vascular invasion is a prognostic factor for poor overall survival (OS) in patients with HCC [2, 3]. Compared to portal and hepatic veins, inferior vena cava (IVC) was less frequently involved by HCC. IVC tumor thrombus may flow into heart and lung, leading to pulmonary embolism and lung metastasis. Patients with HCC involving IVC had an increased risk of sudden death and dismal treatment outcome [4, 5]. Some retrospective studies have suggested that RT is a feasible and safe option to palliate HCC with IVC invasion with pooled 1-year OS rate of 53.6%, response rate of 59.2% and possible severe complication rate of 1.2% [6]. Hepatocellular carcinoma (HCC) with inferior vena cava (IVC) involvement is a rare disease with poor prognosis. This study aimed to evaluate the outcome of HCC patients receiving radiotherapy (RT) to IVC tumor thrombus
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