External-beam radiation therapy versus surgery in the treatment of hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombi.

BACKGROUND

Both surgery and external-beam radiotherapy are effective treatments for hepatocellular carcinoma (HCC) patients with inferior vena cava/right atrium (IVC/RA) tumor thrombi. At present, it is not clear which modality is more suitable. We therefore compared outcomes between surgery and radiotherapy for these patients.

METHODS

We retrospectively reviewed 108 HCC patients with IVC/RA tumor thrombi who were referred for surgery (n = 51) and external-beam radiotherapy (n = 57) at three institutions. Different surgical methods were selected according to the classification of the tumor thrombus. Radiotherapy was designed to focus on primary intrahepatic tumors and tumor thrombi. Predictors of time to progression (TTP) were identified by using univariate and multivariate analyses.

RESULTS

The median TTP was significantly longer in the radiotherapy group than in the surgery group (5.0 months vs 4.2 months; P = 0.010). The multivariate analysis revealed that independent factors predicting shorter TTP were treatment with surgery (HR = 0.577; 95% CI, 0.385-0.865; P = 0.008) and intrahepatic tumor size larger than 10 cm (HR = 0.561; 95% CI, 0.342-0.919; P = 0.022). The median survival times for the radiotherapy and surgery groups were 12.8 and 14.5 months, respectively; the two groups did not have a significant difference in survival (P = 0.466).

CONCLUSIONS

For HCC patients with IVC/RA tumor thrombi, treatment with external-beam radiotherapy and intrahepatic tumor size smaller than 10 cm may predict longer TTP. Compared with complicated surgery, radiotherapy, as a noninvasive treatment modality, may be more likely to be accepted.