Preoperative Stereotactic Body Radiotherapy to Portal Vein Tumour Thrombus in Hepatocellular Carcinoma: Clinical and Pathological Analysis

Abstract

& teruki teshima 1 the prognosis of hepatocellular carcinoma (Hcc) with portal vein tumour thrombus (pVtt) is poor. We conducted a prospective study to evaluate the efficacy and safety of tri-modality therapy, including preoperative stereotactic body radiotherapy (SBRt) and surgery, followed by hepatic arterial infusion chemotherapy (HAic) in Hcc patients with pVtt. in this report, we investigated the pathology of the irradiated PVTT specimen in resected cases and SBRT-related acute toxicity. A total of 8 HCC patients with PVTT received preoperative SBRT targeting the PVTT at a dose of 48 Gy in 4 fractions at our institute from 2012 to 2016. Of the eight patients, six underwent surgery, while the remaining two did not because of disease progression. At the pathological examination, all patients' irradiated pVtt specimens showed necrotic tissue, and three of six patients showed complete pathological response. Two patients showed 30% necrosis with high degeneration and one patient, with 30% necrosis without degeneration, was the only recurrent case found during the follow-up period (median: 22.5, range: 5.9-49.6 months). No SBRT-related acute toxicity worse than grade 2 was observed from SBRT to surgery. In conclusion, the preoperative SBRT for HCC was pathologically effective and the acute toxicities were tolerable.

Efficacy and Safety of the Radiotherapy for Liver Cancer: Assessment of Local Controllability and Its Role in Multidisciplinary Therapy

“…We have also demonstrated the safety and efficacy of radiotherapy for PVTT-complicated HCC cases. PVTT is a poor prognostic factor, and the choice of therapeutic strategy among surgical resection, TACE, radiotherapy, and chemotherapy has not been established [ 15 , 16 , 17 ]. Our results showed that HCC patients with PVTT treated with radiotherapy achieved a three-year survival rate of 75%.…”

Tumor multifocality and serum albumin levels can identify groups of patients with hepatocellular carcinoma and portal vein thrombosis having distinct survival outcomes

“… Kaplan-Meier Analysis Univariate Cox regression N Median Survival time (months) (95% C.I.) Log-Rank p-value HR ∗ (95% CI) HR p-value Combination Nodule # & serum Albumin (g/dL) # Nodules (≤2) & Albumin (≥3.5) a 312 17 mo [ [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] ]. <0.0001 Reference # Nodules (≤2) & Albumin (<3.5) b 477 8 mo [ [7] , [8] , [9] ].…”

“… (95% C.I.) Log-Rank p-value HR ∗ (95% CI) HR p-value Combination Nodule # & serum Albumin (g/dL) Nodule # (≤2) & Albumin (≥3.5) a 139 21 mo [ [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ]. <0.0001 Reference Nodule # (≤2) & Albumin (<3.5) b 186 9 mo [ [8] , [9] , [10] , [11] , [12] , [13] ].…”

“… <0.0001 Reference Nodule # (≤2) & Albumin (<3.5) b 186 9 mo [ [8] , [9] , [10] , [11] , [12] , [13] ]. 1.56 (1.20–2.02) 0.001 Nodule # (>2) & Albumin (≥3.5) b 50 12 mo [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ]. 1.48 (1.02–2.15) 0.04 Nodule # (>2) & Albumin (<3.5) c 73 5 mo [ [4] , [5] , [6] , [7] ].…”

“…However, multiple reports suggest that resection for HCC patients with PVT has a survival advantage [ 16 , 17 ], although it is not clear that liver transplantation does, except a very recent report concerning treatment of PVT patients with neo-adjuvant stereotactic body radiotherapy (SBRT) prior to liver transplant, which seems to confer a survival benefit [ 18 ]. In this context, other reports have begun to show responses of the PVT to various forms of radiation and possibly also with associated survival benefits [ [19] , [20] , [21] ]. Additionally, chemoembolization of HCC patients with PVT who have a tumor response has also been reported to be associated with a survival advantage [ 22 ].…”