Faculty of Medicine, Division of Radiation Oncology, Department of Radiology, Chulalongkorn University, Bangkok, Thailand.
Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
PLoS One. 2021 Sep 23;16(9):e0257556. doi: 10.1371/journal.pone.0257556. eCollection 2021.
In Thailand, individuals with hepatocellular carcinoma (HCC) who develop portal vein tumor thrombosis (PVTT) have a restricted treatment option because to the extent of the disease, poor underlying liver function, and non-coverage of immuno/targeted therapy. Radiotherapy (RT) plays an increasingly important function in these patients. To investigate the feasibility, efficacy, and adverse event rates, we performed a retrospective analysis of patients with HCC with PVTT who underwent 3-dimensional conformal radiation (3DCRT), intensity-modulated radiation (IMRT), volumetric-modulated radiotherapy (VMAT), and stereotactic body radiotherapy (SBRT) in a single-institution.
To examine clinical results in terms of overall survival (OS), local control (LC), response of primary tumor and PVTT, hepatic and gastrointestinal adverse reaction, and prognosis variables for OS and LC.
Between July 2007 and August 2019, non-metastatic HCC with PVTT patients treated with RT were retrospectively reviewed and evaluated.
The analysis included data from 160 patients. The mean age of the patients was 60.8 years ((95% CI 58.2-62.0). The median diameter of the tumor was 7.7 cm (range: 1-24.5). 85 (54.5%) individuals had PVTT in the main or first branch. At 1.8-10 Gy per fraction, the mean biologically effective dose (BED) as α/β ratio of 10 was 49.6 (95% CI 46.7-52.5) Gy10. The median survival time was 8.3 (95% CI 6.1-10.3) months. Survival rates at one and two years were 39.6% and 17.1%, respectively. Estimated incidence of local failure using competing risk analysis were 24% and 60% at 1 and 2 years, respectively. The overall response rate was 74%, with an 18.5 percent complete response rate. In multivariate analysis, tumor size, overall response, and radiation dose were all significant prognostic variables for OS. Hepatic unfavorable events of grade 3 and 4 were for 14.1% of the total. There was no occurrences of grade 3-4 gastrointestinal toxicity, either acute or late. Additionally, there were no treatment-related mortality.
Advanced RT is regarded as a safe and effective therapeutic option for HCC with PVTT. Overall survival was clearly related to tumor size, radiation dose, and tumor/PVTT response. Individuals with BED 56 Gy10 had significantly better overall survival than patients with BED 56 Gy10. A prospective randomized trial is required to validate these outcomes in order to corroborate these findings.
在泰国，患有肝细胞癌（HCC）并发生门静脉癌栓（PVTT）的患者由于疾病的严重程度、潜在肝功能不良和免疫/靶向治疗的覆盖范围有限，治疗选择有限。放射治疗（RT）在这些患者中发挥着越来越重要的作用。为了研究可行性、疗效和不良事件发生率，我们对在单一机构接受三维适形放疗（3DCRT）、调强放疗（IMRT）、容积调强放疗（VMAT）和立体定向体部放疗（SBRT）的 HCC 合并 PVTT 患者进行了回顾性分析。
根据总生存期（OS）、局部控制（LC）、原发肿瘤和 PVTT 的反应、肝和胃肠道不良反应以及 OS 和 LC 的预后变量来检查临床结果。
2007 年 7 月至 2019 年 8 月，对接受 RT 治疗的非转移性 HCC 合并 PVTT 患者进行了回顾性分析和评估。
该分析纳入了 160 例患者的数据。患者的平均年龄为 60.8 岁（95%CI 58.2-62.0）。肿瘤的中位直径为 7.7cm（范围：1-24.5cm）。85 例（54.5%）患者的主或第一分支有 PVTT。在 1.8-10Gy/分次时，α/β 比为 10 的平均生物有效剂量（BED）为 49.6Gy10（95%CI 46.7-52.5）。中位生存时间为 8.3 个月（95%CI 6.1-10.3）。一年和两年的生存率分别为 39.6%和 17.1%。使用竞争风险分析估计的局部失败发生率分别为 1 年时的 24%和 2 年时的 60%。总体反应率为 74%，完全缓解率为 18.5%。多因素分析显示，肿瘤大小、总体反应和放疗剂量均为 OS 的显著预后因素。总的肝脏不良事件发生率为 3 级和 4 级的为 14.1%。未发生 3-4 级急性或迟发性胃肠道毒性。此外，没有治疗相关的死亡。
晚期 RT 被认为是 HCC 合并 PVTT 的一种安全有效的治疗选择。总体生存明显与肿瘤大小、放疗剂量和肿瘤/PVTT 反应有关。BED56Gy10 的患者的总生存率明显优于 BED56Gy10 的患者。需要前瞻性随机试验来验证这些结果，以证实这些发现。
