Department of Radiotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Department of Chemotherapy, Oncology Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Technol Cancer Res Treat. 2021 Jan-Dec;20:1533033821995286. doi: 10.1177/1533033821995286.
Type Ⅲ and Ⅳ portal vein tumor thrombi (PVTT) cannot be removed through surgery, and no effective therapeutic procedure is available. Type Ⅲ/Ⅳ PVTT can be downstage to type I/II PVTT by using Radiotherapy, and can further be can be removed surgically. Thus, radiotherapy may be an effective treatment for type Ⅲ/Ⅳ PVTT. This study aims to evaluate the efficacy and toxicity of radiotherapy for type III-IV PVTT.
This prospective study was conducted from August 1, 2017, to September 30, 2019, for patients with type Ⅲ and Ⅳ PVTT. Patients received radiotherapy with a target dose of 50Gy/25f or 59.5Gy/17 f. Advanced radiological technique such as image fusion technique for CT image and MRI image were utilized to produce more precise lesion localization, and limit the dose to organs at risk in order to get a better downstage rate and less adverse complications.
Nine (9) patients with type Ⅲ PVTT and 5 patients with type Ⅳ PVTT were included in this study. 12 patients received a radiotherapy dose of 50Gy/25f, 2 patients received 59.50Gy/17 f. After radiotherapy, 92.9% of patients with PVTT were successfully downstage to type II/I. In patients with primary hepatocellular carcinoma, 8 patients (accounting 88.9%) achieved down-stage. 5 patients with other types of tumors achieved downstage which accounts 100%. In addition, none of the 14 patients observed radiation hepatitis and radiation liver failure. And none of the patients developed gastrointestinal ulcers and thrombocytopenia.
Radiotherapy is a suitable treatment measure for type Ⅲ and Ⅳ PVTT to get downstage and make the opportunity for surgery. Image fusion technology for precise lesion location such as CT-MRI image fusion, and strict dose limitation of organ at risk, contributed to the improvement of radiotherapy efficiency and the significant decrease in adverse complications.
Ⅲ型和Ⅳ型门静脉癌栓（PVTT）无法通过手术切除，也没有有效的治疗方法。通过放疗可将Ⅲ/Ⅳ型 PVTT 降期为Ⅰ/Ⅱ型 PVTT，然后进一步手术切除。因此，放疗可能是治疗Ⅲ/Ⅳ型 PVTT 的有效方法。本研究旨在评估放疗治疗Ⅲ/Ⅳ型 PVTT 的疗效和毒性。
本前瞻性研究于 2017 年 8 月 1 日至 2019 年 9 月 30 日进行，纳入Ⅲ型和Ⅳ型 PVTT 患者。患者接受 50Gy/25f 或 59.5Gy/17f 的目标剂量放疗。先进的放射技术，如 CT 图像和 MRI 图像的图像融合技术，用于产生更精确的病变定位，并限制危及器官的剂量，以获得更高的降期率和更少的不良反应并发症。
本研究纳入了 9 例Ⅲ型 PVTT 患者和 5 例Ⅳ型 PVTT 患者。12 例患者接受 50Gy/25f 放疗剂量，2 例患者接受 59.50Gy/17f 放疗剂量。放疗后，92.9%的 PVTT 患者成功降期为Ⅱ/Ⅰ型。原发性肝细胞癌患者中，8 例（88.9%）降期。5 例其他类型肿瘤患者降期，占 100%。此外，14 例患者均未观察到放射性肝炎和放射性肝功能衰竭。也没有患者发生胃肠道溃疡和血小板减少症。
放疗是治疗Ⅲ型和Ⅳ型 PVTT 的一种合适的治疗措施，可以使患者降期并获得手术机会。精确的病变定位，如 CT-MRI 图像融合，以及严格的危及器官剂量限制，有助于提高放疗效率，显著降低不良反应并发症。
