Advanced hepatocellular carcinoma with major portal vein invasion: Therapeutic outcomes of hepatic arterial infusion chemotherapy vs concurrent radiotherapy

Abstract

Background: Hepatocellular carcinoma (HCC) with major portal vein invasion (MPVI) presents very poor outcomes. Hepatic artery infusion chemotherapy (HAIC) and radiation therapy (RT) have both been found to be effective for advanced HCC. In this retrospective study, we compared the therapeutic outcomes of our “new HAIC regimen with and without concurrent RT, before and after propensity score matching (PSM) in treating HCC patients with MPVI. Methods: 140 patients with MPVI received HAIC alone and 35 patients underwent concurrent HAIC and RT during a 16-year period. The left subclavian artery was adopted as the entry site for a temporary catheter placement for a 5-day chemoinfusion. The Modified Response Evaluation Criteria in Solid Tumors (mRECIST) was adopted to assess the objective response rate (ORR). The Kaplan-Meier curve was used to calculate progression-free survival (PFS) and overall survival (OS) between the two groups. Univariate and multivariate analyses by Cox’s regression model were used to assess hazard ratios. Results: Of the 140 patients with Child-Pugh A liver function, the median OS was 17.0 months. In the initial cohort, higher ORR and PFS were found in the concurrent RT group than in the HAIC alone group (80% vs 66.4% and 9 vs 8 months, respectively) but shorter OS (10.5 vs 14.5 months, p=0.039) were observed. After PSM, the OS was 10 and 15 months (p=0.012), respectively. Multivariable Cox regression analysis revealed that the significant factors for adjusting hazard ratios for OS were Child-Pugh classification, AFP level, and hepatic vein invasion. Conclusion: HAIC is an effective treatment for advanced HCC patients with MPVI. Concurrent HAIC and full dose RT was associated with worse clinical outcomes.

Proton Beam Therapy for Treating Patients with Hepatocellular Carcinoma with Major Portal Vein Tumor Invasion: A Single Center Retrospective Study

“…Surgery and radiofrequency are often difficult to perform for locally advanced PVTT, and cases treated with molecularly targeted drugs and cytotoxic chemotherapy have poor prognoses [ 19 , 20 , 21 ]. The Efficacies of hepatic arterial infusion chemotherapy (HAIC) and transarterial radioembolization (TARE) for PVTT are expected, but they have not been established as standard treatment modalities [ 21 , 22 , 23 ]. Radiation therapy for HCC is often used in cases where surgery or RFA is not feasible or for palliation of symptoms [ 24 , 25 , 26 ].…”