Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Int J Radiat Oncol Biol Phys. 2010 Sep 1;78(1):180-7. doi: 10.1016/j.ijrobp.2009.07.1730. Epub 2009 Nov 18.
To evaluate the effects of transarterial chemoembolization (TACE) and three-dimensional conformal radiotherapy (CRT) in patients with hepatocellular carcinoma (HCC) and inferior vena cava tumor thrombus (IVCTT).
A total of 42 consecutive patients who underwent TACE and CRT (TACE+CRT group) for the treatment of HCC with IVCTT were prospectively enrolled from July 2004 to October 2006. As historical controls, 29 HCC patients with IVCTT who received TACE alone (TACE group) between July 2003 and June 2004 were included. CRT was designed to target only the IVCTT and to deliver a median total dose of 45 Gy (range, 28-50 Gy).
Most baseline characteristics of the two groups were similar (p > 0.05). The response and progression-free rates of IVCTT were significantly higher in the TACE+CRT group than in the TACE group (42.9% and 71.4% vs. 13.8% and 37.9%, respectively; p < 0.01 for both rates). Overall, patient survival was significantly higher in the TACE+CRT group than in the TACE group (p < 0.01), with a median survival time of 11.7 months and 4.7 months, respectively. Treatment with TACE+CRT (hazard ratio [HR] = 0.38; 95% confidence interval [CI], 0.20-0.71), progression of IVCTT (HR = 4.05; 95% CI, 2.00-8.21), Child-Pugh class B (HR = 3.44; 95% CI, 1.79-6.61), and portal vein invasion (HR = 2.31; 95% CI, 1.19-4.50) were identified as independent predictors of mortality by multivariable analysis.
The combination of TACE and CRT is more effective in the control of IVCTT associated with HCC and improves patient survival compared with TACE alone.
评估经动脉化疗栓塞（TACE）联合三维适形放疗（CRT）治疗肝细胞癌（HCC）合并下腔静脉癌栓（IVCTT）的疗效。
2004 年 7 月至 2006 年 10 月，前瞻性纳入 42 例接受 TACE+CRT 治疗 HCC 合并 IVCTT 的患者（TACE+CRT 组）。作为历史对照，纳入 2003 年 7 月至 2004 年 6 月期间仅接受 TACE 治疗的 29 例 HCC 合并 IVCTT 患者（TACE 组）。CRT 仅针对 IVCTT 进行设计，中位总剂量为 45 Gy（范围 28-50 Gy）。
两组的大多数基线特征相似（p＞0.05）。TACE+CRT 组 IVCTT 的反应率和无进展生存率明显高于 TACE 组（分别为 42.9%和 71.4%比 13.8%和 37.9%；p＜0.01）。总体而言，TACE+CRT 组患者的生存率明显高于 TACE 组（p＜0.01），中位生存时间分别为 11.7 个月和 4.7 个月。TACE+CRT（风险比[HR]=0.38；95%置信区间[CI]，0.20-0.71）、IVCTT 进展（HR=4.05；95%CI，2.00-8.21）、Child-Pugh 分级 B（HR=3.44；95%CI，1.79-6.61）和门静脉侵犯（HR=2.31；95%CI，1.19-4.50）是多变量分析中死亡的独立预测因素。
与单独 TACE 相比，TACE 联合 CRT 更能有效控制 HCC 合并 IVCTT，并提高患者生存率。
