Safety and Efficacy of Transcatheter Arterial Chemoembolization Plus Radiotherapy Combined With Sorafenib in Hepatocellular Carcinoma Showing Macrovascular Invasion.

Xu Zhu,Dezuo Dong,Song Gao,Hongzhi Wang,Weihu Wang,Xianggao Zhu,Yuting Zhao

doi:10.3389/fonc.2019.01065

Abstract

The safety and efficacy of transcatheter arterial chemoembolization (TACE) plus intensity-modulated radiotherapy (IMRT) combined with sorafenib in hepatocellular carcinoma (HCC) showing macrovascular invasion (MVI) remain controversial. The records of 63 patients with HCC showing MVI, who underwent IMRT plus TACE combined with (28 participants; Group A) or without (35 participants; Group B) sorafenib from 2015 to 2018, were retrospectively reviewed to assess the progression-free survival (PFS), overall survival (OS), and treatment-associated toxicity. The median PFS was longer in Group A (13.6 months) than in Group B (9.2 months), and still significant after propensity score matching (PSM). However, the median OS was similar in the two groups (19.0 vs. 15.2 months, P = 0.094 before PSM; P = 0.204 after PSM). The grade 3 hematologic and hepatic toxicity was present in 10 (15.9%) and 7 (11.1%) patients, respectively. The incidence of skin reaction, hand-foot syndrome, and diarrhea, all grade 1–2 adverse events, was significantly higher in Group A than in Group B. No patient experienced grade 4 or 5 toxicity, and radiation-induced liver disease was also not observed. TACE plus IMRT combined with sorafenib showed a good safety profile and clinical benefit in patients with HCC having MVI.

Highlights

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide [1]
This study demonstrated that, compared with Transcatheter arterial chemoembolization (TACE) plus intensity-modulated radiotherapy (IMRT), TACE plus radiation therapy (RT), and sorafenib significantly increased the median time to progression in patients with hepatocellular carcinoma (HCC) and macrovascular invasion (MVI) (13.6 vs. 9.2 months, P = 0.044)
Tumor thrombosis was common during the natural history of HCC and led to a worse prognosis compared with that in patients without MVI [3, 6]

Summary

Introduction

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide [1]. It is the fourth most common cancer and the second leading cause of cancer mortality in China [2]. 10–40% of patients at the time of diagnosis of HCC, promotes intrahepatic tumor spread and causes deterioration of liver function [3, 4]. Patients with HCC complicated by MVI have an extremely poor prognosis, with a median survival time of 2–4 months, and are treated with supportive care [5]. Recent studies showed that HCC with MVI might benefit from locoregional therapies alone or the combination of locoregional and systemic treatments compared with sorafenib. TACE combined with radiation therapy (RT) has been suggested [8, 9]

Methods

Results

Conclusion