Abstract
Background and ObjectiveTo compare the survival outcomes of patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) who received transarterial chemoembolization (TACE) before or after intensity-modulated radiotherapy (IMRT).MethodsDuring the study period, the survival outcomes of HCC patients with PVTT who underwent TACE before (TACE-RT) or after IMRT (RT-TACE) were compared. Using propensity score matching (PSM), matched pairs of patients were compared.ResultsThere were 76 patients in the TACE-RT group and 36 patients in the RT-TACE group. Using a 2:1 matching, 75 patients were included into this study after PSM: 50 patients in the TACE-RT group and 25 patients in the RT-TACE group. Before PSM, patients in the RT-TACE group showed significantly better survival when compared with the TACE-RT group (median survival, 13.2 months vs.7.4 months; P = 0.014) for patients with main trunk PVTT, and after PSM, the corresponding median survival was 13.2 months vs.7.4 months (P = 0.020). When compared with TACE-RT, RT-TACE had a significantly lower rate of worsening in liver function (9.5% vs. 33.3%, P = 0.044) for patients with main trunk PVTT.ConclusionsFor HCC patients with main trunk PVTT, IMRT followed by TACE yielded better survival outcomes and liver function when compared to TACE followed by IMRT.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second most common cause of cancer-related mortality [1]
Before propensity score matching (PSM), patients in the RT-transarterial chemoembolization (TACE) group showed significantly better survival when compared with the TACE-RT group for patients with main trunk portal vein tumor thrombus (PVTT), and after PSM, the corresponding median survival was 13.2 months vs.7.4 months (P = 0.020)
For hepatocellular carcinoma (HCC) patients with main trunk PVTT, intensity-modulated radiotherapy (IMRT) followed by TACE yielded better survival outcomes and liver function when compared to TACE followed by IMRT
Summary
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second most common cause of cancer-related mortality [1]. The combination of TACE and radiotherapy for HCC patients with PVTT significantly improved survival outcomes when compared with TACE or radiotherapy alone [1219]. While most of these studies used TACE followed by RT, some applied RT before TACE [17]. The survival outcomes and adverse events of a cohort of HCC patients with different extent of PVTT underwent TACE either before or after IMRT were compared. To compare the survival outcomes of patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) who received transarterial chemoembolization (TACE) before or after intensity-modulated radiotherapy (IMRT)
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