Abstract
Purpose. The purpose is to evaluate the feasibility, efficacy, and the toxicity of three-dimensional conformal radiotherapy (3DCRT) in patients with advanced hepatocelluar carcinoma (HCC) and inferior vena cava tumor thrombosis (IVCTT). Methods. Between 2007 and 2012, in a retrospective way, 9 patients (median age 69 years) with advanced HCC and IVCTT unfit for surgery, radiofrequency ablation, embolization, or chemotherapy were treated with three-dimensional conformal radiotherapy (3DCRT). The radiotherapy volume included both primary tumor and IVTT. The radiotherapy schedule was 50–52 Gy in 2 Gy fractions. Overall survival (OS), response to radiotherapy, visual analogue scale (VAS), and toxicity were assessed. Results. All patients demonstrated a response rate up to 60%. During radiotherapy, 3 patients experienced grade 1 nausea/vomit toxicity. All patients demonstrated an elevation of the liver enzymes (3 patients with grade 1 and 6 patients with grade 2). The mean VAS-score was decreased from 6.11 to 3.11, while the median overall survival was 24 months. Conclusion. 3DCRT achieves a very high local control rate and is suitable for patients with HCC and IVTT, while the documented radiation induced toxicity is moderate. It can be recommended for palliation in patients unable to undergo curative therapies.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the third most common cause of cancer-related death, following lung cancer and stomach cancer in the whole world [1].Patients suffering from chronic Hepatitis B have a tendency in appearing hepatocelluar carcinoma (HCC)
The aim of our study is to investigate the potential efficacy together with the acute toxicity in patients with cirrhosis, advanced HCC, and IVTT that are unfit for resection, ablation, or chemotherapy
We are reporting our results from a retrospective study of selective patients with advanced HCC and IVTT that were not eligible for surgery, radiofrequency ablation, embolization, or chemotherapy that were treated with threedimensional conformal radiotherapy (3DCRT)
Summary
Patients suffering from chronic Hepatitis B have a tendency in appearing HCC. Hepatitis C and aflatoxin B exposure are other usual risk factors [2]. Partial hepatectomy is the treatment of choice for patients with good liver function and resectable tumors. According to Milan criteria, liver transplantation can offer cure to people with advanced cirrhosis and tumors smaller than 5 cm in greatest dimension, or up to 3 tumors each smaller than 3 cm, with no extrahepatic spread and without vascular invasion [3]. For patients who are not surgical candidates but have tumors smaller than 3 to 4 cm in size, percutaneous ablation, or radiofrequency ablation (RF) can offer long term control.
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