J Korean Soc Ther Radiol Oncol.  2011 Mar;29(1):36-43. 10.3857/jkstro.2011.29.1.36.

Radiation Therapy for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

• Park SG
• Kim JH
• Byun SJ
• Kim OB
• Hwang JS
• Oh YK
• Choi TJ

• KMID: 2097251
• DOI: http://doi.org/10.3857/jkstro.2011.29.1.36

Abstract

PURPOSE
To evaluate the effectiveness of radiation therapy (RT) for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) and to analyze the prognostic factors.
MATERIALS AND METHODS
From December 2004 to April 2009, 70 patients who had HCC with PVTT were treated with RT at Keimyung University Dongsan Medical Center. Nineteen patients whose total dose was below 30 Gy and one patient who underwent liver transplantation were excluded. The remaining 50 patients (45 males, 5 females; median age 55 years) were analyzed. According to the LCSGJ TNM stage, there were 27 patients (54.0%) with stage III and 23 (46.0%) with stage IV. Total dose of 30~54 Gy was administered (median 45). Thirty patients (60.0%) were treated with concurrent chemoradiation therapy (CCRT). The median follow-up duration was from 13.5 months (range, 3 to 70 months).
RESULTS
The median survival time from the start of RT was 9 months. One-year and 2-year overall survival rates were 24.9% and 11.2%, respectively. At the follow-up time, three patients (6.0%) displayed no evidence of disease. Seven patients (14.0%) were alive with disease, and 40 (80.0%) patients had expired due to disease progression. CCRT was associated with worse survival than RT alone (p=0.034). Response to RT (p=0.037), CLIP stage (p=0.017), and TNM stage (p=0.041) were statistically significant prognostic factors. There was no radiation-induced liver disease.
CONCLUSION
RT is an effective and safe modality for HCC with PVTT. Further studies such as prospective randomized trials are needed to confirm the role of RT for HCC with PVTT.

Keyword

Hepatocellular carcinoma; Portal vein; Radiotherapy; Concurrent chemoradiotherapy

MeSH Terms

Carcinoma, Hepatocellular
Chemoradiotherapy
Disease Progression
Follow-Up Studies
Humans
Liver
Liver Transplantation
Male
Portal Vein
Survival Rate
Thrombosis