Outcomes with radiotherapy in multimodality treatment for hepatocellular carcinoma with portal vein tumour thrombosis

作者：Puja Sahai, Hanuman Prasad Yadav, Ashok Choudhury, Saggere Muralikrishna Shasthry, Ankur Jindal, Aprajita Mall, Amar Mukund, Yashwant Patıdar, Mangu Srinivas Bharadwaj, Bangkim Chandra Khangembam, Guresh Kumar, Archana Rastogi, Viniyendra Pamecha · 发表于：BJR|Open · 年份：2024 · DOI：10.1093/bjro/tzaf002 · 被引用次数：6 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Liver Disease and Transplantation、Cholangiocarcinoma and Gallbladder Cancer Studies

Abstract Objectives The purpose of the present study was to evaluate outcomes with radiation therapy (RT) in multimodality treatment for inoperable hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT). Methods The present retrospective study included 24 patients without extrahepatic metastases. The patients had received drug eluting beads - transarterial chemoembolization (DEB-TACE) (n = 10) and systemic treatment (n = 14) before RT. The dose fractionation was 12–31.5 Gy in 3–7 fractions of 4–5 Gy to PVTT or PVTT plus the liver parenchymal tumour. All patients were advised systemic treatment with sorafenib, lenvatinib, or nivolumab after RT. After RT, patients had received DEB-TACE within 8 weeks (n = 2) or at 5–10 months (n = 3). Treatment response was evaluated as per mRECIST and PERCIST, and Kaplan-Meier survival analysis was performed. Results The disease control rate in PVTT was 50% at 3 months. The median overall survival (OS) was 10.9 months (95% CI, 0.74-21) for all patients. The 6-month, 1-year, 2-year, and 3-year OS rates were 75%, 45.8%, 25%, and 12.5%, respectively. The median OS was 30.4 months (95% CI, 12.1-48.7) versus 18.1 months (0.00-38.8) with complete or partial response versus stable or progressive disease in PVTT (P = .036). Eleven patients had a decline in Child Pugh score of 2 or more points within 3 months after RT. One patient underwent live donor liver transplantation (LDLT) and complete necrosis with no viable tumour was observe...