International Journal of Radiation Oncology*Biology*Physics
Clinical investigationsLiverA comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus
Introduction
The incidence of portal vein (PV) and/or inferior vena cava (IVC) tumor thrombi is higher in patients with hepatocellular carcinoma (HCC); it has been reported in as many as 44–84% of these patients in autopsy data (1). It has also been estimated, from clinical data, that the incidence of HCC thrombosis ranges between 34% and 50% (2, 3). Most of these patients have a poorer prognosis (4); their duration of survival is only 2.4–2.7 months without treatment (4, 5, 6, 7). If patients with PV or IVC thrombi receive systemic chemotherapy, the median survival time is 3.9–9.2 months (7, 8). Transarterial chemoembolization (TACE) has also been attempted in patients with major PV invasion, and the median survival time in these patients is between 10 months and 1 year (9, 10). The mean survival is likely longer in patients with PV tumor thrombosis who are treated with hepatectomy and preoperative TACE (11). However, both TACE and surgical resection are not indicated for HCC with PV trunk occlusion by tumor thrombi because of a lack of efficacy and possible complications. There is no choice but external beam radiation therapy (EBRT) in such cases. Some studies have reported survival of 7–12 months in patients with PV thrombus who receive EBRT (12, 13), but the number of cases was smaller, and there was no control group. In the present study, we report the preliminary results for 44 patients with HCC who had PV and/or IVC thrombi and who received EBRT, alone or in combination with additional therapy (TACE or removal of primary tumors), and compared them with 114 patients with HCC who had PV and/or IVC tumor thrombi treated without EBRT.
Section snippets
Patients
We conducted a retrospective chart review of 158 patients with HCC who had PV and/or IVC/atrium tumor thrombi diagnosed and treated at the Zhongshan Hospital, Fudan University (Shanghai, China), from January 1998 to August 2003. During this period, 1926 patients with HCC were hospitalized at the Liver Cancer Institute, Zhongshan Hospital, including 158 patients with tumor thrombi in PV and/or IVC. The proportion of HCC with tumor thrombi is as low as 8.2% in our data, whereas the incidence of
Distributions of tumor thrombus
In the 158 patients with HCC who had PV and/or IVC/atrium tumor thrombosis examined in the present study, the distribution of thrombi was 34.8% (55 of 158) in the PV branches, 44.3% (70 of 158) in the PV trunk, and 20.9% (33 of 158) in the IVC/atrium.
Overall survival analysis and prognostic factors
The Kaplan-Meier survival curves in Fig. 2 show that patients with similar AFP status, intrahepatic tumor type, and thrombus location had virtually identical survival rates, but survival decreased as the stage increased but increased for the
Discussion
Historically, the use of radiation was largely limited to unresectable advanced primary liver cancer treated during the pre-CT era, and this led to the conclusion that primary liver cancers are radioresistant. There is, however, no evidence that primary liver cancers have an inherent radioresistance; rather, the doses of radiation administered have generally been limited by the need to avoid damage to the surrounding structures. Over the past decade, we have used CT scans to design radiation
References (32)
- et al.
Prognostic features and survival of hepatocellular carcinoma in ItalyImpact of stage of disease
Eur J Cancer
(2001) - et al.
Clinicopathologic features and postoperative prognosis of multicentric small hepatocellular carcinoma
J Am Coll Surg
(2000) - et al.
Portal vein thrombosis in hepatocellular carcinomaAge and sex distribution in an autopsy study
J Cancer Res Clin Oncol
(1998) - et al.
Hepatocellular carcinoma in the United StatesPrognostic feature, treatment outcome, and survival
Cancer
(1996) - et al.
An analysis of 412 cases of hepatocellular carcinoma at a Western Center
Ann Surg
(1999) A new prognostic system for hepatocellular carcinomaA retrospective study of 435 patients
Hepatology
(1998)- et al.
Clinical characteristics and outcome of a cohort of 101 patients with hepatocellular carcinoma
World J Gastroenterol
(2001) - et al.
Natural history of untreated nonsurgical hepatocellular carcinomaRationale for the design and evaluation of therapeutic trials
Hepatology
(1999) - et al.
A novel chemotherapy for advanced hepatocellular carcinoma with tumor thrombosis of the main trunk of the portal vein
Cancer
(1997) - et al.
Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-α for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis
Cancer
(2000)
Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosisAnalysis of 48 cases
Cancer
Transcatheter arterial embolization for hepatocellular carcinoma with portal vein thrombosis
J Gastroenterol Hepatol
Selection criteria for hepatectomy in patients with hepatocellular carcinoma and portal vein tumor thrombus
Ann Surg
A pilot study of three dimensional conformal radiotherapy in unresectable hepatocellular carcinoma
J Gastroenterol Hepatol
Radiotherapy after transcatheter arterial chemoembolization for patients with hepatocellular carcinoma and portal vein tumor thrombus
Am J Clin Oncol
Imaging of hepatocellular carcinoma
J Gastroenterol Hepatol
Cited by (169)
Hepatocellular Carcinoma with Hepatic Vein and Inferior Vena Cava Invasion
2023, Journal of Clinical and Experimental HepatologyRole of rapid arc-image-guided radiotherapy in hepatocellular carcinoma with portal vein tumor thrombosis: A study from tertiary care center in Punjab, India
2023, Journal of Cancer Research and Therapeutics