Korean J Hepatol.  2007 Sep;13(3):378-386. 10.3350/kjhep.2007.13.3.378.

Efficacy of Transarterial Chemolipiodolization with or without 3-Dimensional Conformal Radiotherapy for Huge HCC with Portal Vein Tumor Thrombosis

• You CR
• Jang JW
• Kang SH
• Bae SH
• Choi JY
• Yoon SK
• Choi IB
• Lee DH
• Chun HJ
• Choi BG

• KMID: 760739
• DOI: http://doi.org/10.3350/kjhep.2007.13.3.378

Abstract

BACKGROUND/AIMS: The treatment efficacy for advanced hepatocellular carcinoma is poor. This study examined the efficacy and toxicity of 3-dimensional conformal radiotherapy (3D-CRT) in combination with transarterial chemolipiodolization (TACL) for a huge hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). METHODS: From March 2001 to November 2004, 49 patients with advanced HCC with PVTT (size>8 cm, modified UICC stage IVa) were enrolled in this retrospective study. Twenty two patients underwent more than 2 cycles of TACL (adriamycin 50 mg/m2, cisplatin 60 mg/m2, 5-fluorouracil 200 mg/m2 every 4-6 weeks) without 3D-CRT, while 27 patients underwent consecutive TACL with 3D-CRT (40-45 Gy for 4-5 weeks) that was started one week after the 1st TACL. The response was assessed by a computed tomography (CT) and the serum alpha-fetoprotein (AFP) level at 1-2 month intervals. RESULTS: The objective response rates in the TACL group and TACL with 3D-CRT group were 18% and 48% at 3 months (P=0.051), and 10.5% and 42% at 6 months (P=0.024) respectively. The median survival time was 13 months and 13.5 months in TACL and TACL with 3D-CRT groups, respectively (P=0.502). The treatment response was better in the TACL with 3D-CRT group but there was no significant difference in survival between the two groups. Most toxicities in the two groups were mild, not exceeding grade 1 according to the WHO criteria. CONCLUSIONS: For patients with a huge HCC with PVTT, TACL with 3D-CRT achieved some meaningful clinical benefit. Prospective controlled trials will be needed to confirm the real benefit of TACL combined with 3D-CRT.

Keyword

Carcinoma, hepatocellular; Portal vein tumor thrombosis (PVTT); Radiotherapy, conformal; Transarterial chemolipiodolization (TACL); Treatment outcome

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular/complications/radiotherapy/*therapy
Chemoembolization, Therapeutic/*methods
Combined Modality Therapy
Data Interpretation, Statistical
Female
Humans
Liver Neoplasms/complications/radiotherapy/*therapy
Male
Middle Aged
*Portal Vein
Radiotherapy, Conformal/adverse effects/*methods
Severity of Illness Index
Survival Analysis
Venous Thrombosis/etiology/radiotherapy/*therapy