Clinical results of radiotherapy for hepatocellular carcinoma with tumor thrombosis.

Abstract

Background: The aim of this study was to evaluate the clinical outcome of radiotherapy (RT) for hepatocellular carcinoma (HCC) with the portal vein (PV), hepatic vein (HV), inferior vena cava (IVC), and bile duct (BD) tumor thrombosis (TT). Methods: Patients who received RT for the treatment of a primary tumor and tumor thrombosis at Musahino Red Cross Hospital between 2011 and 2019 were retrospectively reviewed. We compared patient characteristics, radiation dose, overall survival (OS), the combined chemotherapy regimen, and objective response rates (ORRs) between the treatment modalities. Results: We evaluated 43 patients who were treated with RT, 27 of whom received combined chemotherapy with RT. The total equivalent dose in 2 Gy fractions ranged from 42.25 to 72 Gy (median 48.75 Gy). The median follow-up period after RT was 13 months (range of 2–90 months). Multivariate analysis showed that the length of tumor thrombosis was a unique significant prognostic factor for OS (p = 0.01) and the prescribed equivalent dose of more than 48.75 Gy significantly contributed to ORRs (p = 0.02). When compared, the one-year OS rates of responders (n = 25) and non-responders (n = 18) were 75% and 35%, respectively (p = 0.009). The odds ratio of ORRs between the two total dose groups (42.35 Gy versus more than 48.75 Gy) was 9.8 (95% CI [2.1, 58.9], p = 0.001). Combined chemotherapy with RT was a prognostic factor for OS (p = 0.03), but it was not correlated with response rate (p = 0.53). Conclusion: Local control of tumor thrombosis was found to be a significant prognostic factor for OS in patients with HCC and its tumor thrombosis. Although various drug and treatment options for tumor thrombosis exist, RT provides a better OS.