Efficacy and Prognosis of Radiotherapy for Hepatocellular Carcinoma with Tumor Thrombosis in Main Portal Vein or/and Vena Cava

Abstract

trial studies combination transarterial chemoembolization (TACE) and Stereotactic Body Radiation Therapy (SBRT) for BCLC A patients with HCC from 4-7 cm. Materials/Methods: Patients were eligible if they were BCLC A, Child-Pugh score 7, had a single HCC from 4-7 cm, no evidence of macrovascular invasion, no evidence of metastatic disease, ECOG 0, and were not suitable for resection or liver transplantation. Treatment consisted of drug-eluting bead (DEB)-TACE at time 0 and 1 month followed by SBRT completed within 2-3 weeks following TACE. Each DEB-TACE treatment utilized 1 vial of 100-300 micron LC Beads (BTG) loaded with 50mg of doxorubicin. SBRT was delivered from 35-50 Gy in 5 fractions. The primary end-point of the study was best objective response by mRECIST (measured 1 month post-treatment and every 3 months thereafter). Secondary endpoints were progression free survival (PFS), cancer specific survival (CSS), overall survival (OS) assessed using the Kaplan-Meier method. Results: From 2014-2018, 25 patients were enrolled in a single institution with a median follow of 18 months (range 1-47). Baseline patient characteristics are shown in Table 1. Every patient completed the protocol as planned except one who only received DEB-TACEx1 before SBRT. 24 patients had at least one post treatment scan to assess mRECIST response (one patient lost to follow up). Best objective response in the target lesion was 92%: 64% complete response (nZ16), 28% partial response (nZ7), 0%stable disease, and 4% progression of disease (nZ1). Median time to CR was 3 months (range 1-17). 1-and 2-year OS was 80% and 67%, respectively. 1-and 2-year PFS was 67% and 52%, respectively. CSS was 91% at 1 year and 83% at 2 years. Conclusion: Preliminary results from this Phase II trial show very promising response rates when combining TACE+SBRT in large, unresectable HCC with excellent OS, PFS, and CSS. These preliminary data are currently being confirmed in an expanded cohort.

Combination Intensity-Modulated Radiotherapy and Sorafenib Improves Outcomes in Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

“…In the current study, we showed similar results with the previous studies. Compared with group B (IMRT alone), group A (IMRT plus sorafenib) displayed a favorable trend in median OS (11.0 versus 9.0 months, P � 0.036), 1 yr and 2 yrs OS (44.9% versus 28.6% and 3.8% versus 2.6%), median PFS (6.0 Recently, Chen et al [23] analyzed sixty-one HCC patients with tumor thrombosis in the main portal vein or vena cava to assess the response and survival of radiotherapy. In the study, the tumor thrombosis exhibited a higher response rate than the primary tumor (83.7% versus 77.1%) in the field of radiotherapy, while the primary failure pattern was the outfield progression.…”

Is the Concurrent Use of Sorafenib and External Radiotherapy Feasible for Advanced Hepatocellular Carcinoma? A Meta-Analysis

“…In contrast, other studies included in the present meta-analysis were more favorable for the application of combination therapy. In terms of toxicities, comparative studies did not report excessive serious toxicities related to the concurrent application [20,21,35,[38][39][40], and single-arm studies reported that the degree of complication was acceptable and severe toxicity (grade ≥4) was rare [19,36,37]. Furthermore, Zhang et al [39] reported that the concurrent application of brachytherapy to the portal vein significantly reduced symptoms due to liver compensation.…”

“…The abstract screening was performed on 295 studies, and a full-text review was performed on 47 studies after excluding 248 studies with irrelevant subjects or formats. A full-text review was performed to identify studies that fully met the inclusion criteria, and 11 studies were finally included in the present study [16,[18][19][20][21][35][36][37][38][39][40]. The selection process is illustrated in Figure 1.…”

“…The abstract screening was performed on 295 studies, and a full-text review was performed on 47 studies after excluding 248 studies with irrelevant subjects or formats. A full-text review was performed to identify studies that fully met the inclusion criteria, and 11 studies were finally included in the present study [16,[18][19][20][21][35][36][37][38][39][40] Among the included studies, eight were from China or Taiwan, and one each was from Canada, Japan, and Korea. Nine studies were published as full-text articles, and two were abstracts published by the American Society for Radiation Oncology (ASTRO).…”