Safety and efficacy of stereotactic body radiotherapy for hepatocellular carcinoma with portal vein

Abstract

Background: To report the safety, efficacy, and toxicity of stereotactic body radiotherapy (SBRT) for the treatment of advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Materials and methods: Seventy patients treated with Linac-based SBRT for HCC with PVTT between Dec 2015 and June 2017 were analyzed. SBRT was designed to target the tumor thrombosis and adjacent primary tumor (if it is feasible). Deliver a median total dose of 40Gy (range, 25-50Gy) in five fractions during one week. Fourty patients received TACE(1-5 cycles) followed SBRT. Three patients received operation followed SBRT. Results: The median follow-up was 10 months. After six months of SBRT, assessments of PVTT response showed complete response(CR) in 2 of 26 (7.6%) patients, partial response(PR) in 15 (57.6%), progression disease(PD) in 6(23.0%),stable disease（SD）in 3 (11.5%), with an objective response rate of 65.2%. No treatment-related Grade 4/5 toxicity was seen within three months after SBRT. The one-year overall survival rate was 36.6%. The predictive factor associated with better survival was response to radiotherapy and SBRT followed by TACE. Conclusions: Linac-based SBRT is a safe and effective treatment option for PVTT in HCC. Prospective randomized controlled trials are warranted to validate the role of SBRT in these patients.