Lin Chun-Shu, Jen Yee-Min, Chiu Su-Yun, Hwang Jing-Min, Chao Hsing-Lung, Lin Hon-Yi, Shum Weng-Yoon
Department of Radiation Oncology, Tri-Service General Hospital, 325 Section 2 Cheng-Kong Rd., Nei-Hu 11490, Taipei, Taiwan, ROC.
Jpn J Clin Oncol. 2006 Apr;36(4):212-7. doi: 10.1093/jjco/hyl006. Epub 2006 Apr 13.
Patients with hepatocellular carcinoma (HCC) often have unresectable tumors. Transcatheter arterial chemoembolization (TACE) is one of the limited alternative treatments that can prolong these patients' survival. However, the presence of portal vein tumor thrombosis (PVTT) is a contraindication for TACE and, therefore, HCC patients with PVTT would be depleted of the advantage of TACE. The purpose of this study was to analyze the recanalization rate of thrombosed portal vein and treatment toxicities after stereotactic radiotherapy (SRT) or three-dimensional conformal radiotherapy (3DCRT).
From March 2002 to November 2004, 43 patients were enrolled in this prospective study. Twenty-two patients were in the SRT group and 21 in the 3DCRT group. For SRT, 3 Gy per fraction, 3 fractions per week, was given to a total dose of 45 Gy. For 3DCRT, a daily dose of 1.8 Gy, 5 fractions per week, was given to a total dose of 45 Gy.
Of the 43 patients, 16 completed the planned radiotherapy. Eventually, 14 patients received evaluation for portal vein recanalization, 8 in the SRT and 6 in the 3DCRT group, respectively. For all patients, the crude response rate was 26%. For 14 evaluable patients, the crude response rate was 79%. It was 75% in the SRT group and 83% in the 3DCRT group (P = 0.71). The median survival time was 6.0 and 6.7 months for the SRT and 3DCRT group, respectively (P = 0.911).
Image-based radiotherapy, either SRT or 3DCRT, can recanalize the PVTT in unresectable HCC patients. Responders also had better 1 year and 2 year survivals. A more strict patient selection criterion may maximize the potential benefits of radiotherapy for hepatoma patients with PVTT.
肝细胞癌（HCC）患者常伴有无法切除的肿瘤。经动脉化疗栓塞术（TACE）是少数几种可延长此类患者生存期的替代治疗方法之一。然而，门静脉癌栓（PVTT）的存在是TACE的禁忌症，因此，伴有PVTT的HCC患者无法从TACE中获益。本研究旨在分析立体定向放射治疗（SRT）或三维适形放射治疗（3DCRT）后门静脉血栓再通率及治疗毒性。
2002年3月至2004年11月，43例患者纳入本前瞻性研究。SRT组22例，3DCRT组21例。SRT每次分割剂量3Gy，每周3次，总剂量45Gy。3DCRT每日剂量1.8Gy，每周5次，总剂量45Gy。
43例患者中，16例完成了计划放疗。最终，14例患者接受了门静脉再通评估，SRT组8例，3DCRT组6例。所有患者的粗缓解率为26%。14例可评估患者的粗缓解率为79%。SRT组为75%，3DCRT组为83%（P = 0.71）。SRT组和3DCRT组的中位生存时间分别为6.0个月和6.7个月（P = 0.911）。
基于影像的放射治疗，无论是SRT还是3DCRT，均可使无法切除的HCC患者的PVTT再通。缓解者的1年和2年生存率也更高。更严格的患者选择标准可能会使放疗对伴有PVTT的肝癌患者的潜在益处最大化。
