Li Zhuoran, Zhai Yirui, Wu Fan, Cao Dayong, Ye Feng, Song Yan, Wang Shulian, Liu Yueping, Song Yongwen, Tang Yuan, Jing Hao, Fang Hui, Qi Shunan, Lu Ningning, Li Ye-Xiong, Wu Jianxiong, Chen Bo
State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People's Republic of China.
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People's Republic of China.
J Hepatocell Carcinoma. 2024 Aug 5;11:1481-1493. doi: 10.2147/JHC.S464140. eCollection 2024.
This study evaluated the clinical outcomes of patients with hepatocellular carcinoma (HCC) with hepatic vein tumor thrombus (HVTT) and/or inferior vena cava tumor thrombus (IVCTT) receiving radiotherapy (RT) combined with systemic therapies.
Patients with HCC with HVTT and/or IVCTT who received RT were identified at our institution. The prescription doses were 30-65 Gy for planning target volume and 40-65 Gy for the gross tumor volume. Targeted therapy and immune checkpoint inhibitors were used concurrently if patients were at a high risk of or already had distant metastasis. After RT completion, follow-up was performed at 1, 3, 6, and 12 months, and 3 to 6 months thereafter. The objective response rate (ORR), overall survival (OS), progression-free survival (PFS) and toxicity were recorded.
Thirty-four patients were retrospectively enrolled between January 2016 and September 2021. Most patients received concurrent targeted therapy (70.6%) and/or post-RT (79.4%). The in-field ORR and disease control rates were 79.4% and 97.1%, respectively. The OS rates were 77.6% at 1 year and 36.3% at 2 years (median OS, 15.8 months). The median PFS and median in-field PFS were 4.2 months and not reached, respectively. The PFS and in-field PFS rates were 24.6% and 79.2% at 1 year, 19.7% and 72.0% at 2 years, respectively. An alpha-fetoprotein level >1000 ng/mL was a significant prognostic factor for worse OS (HR, 5.674; 95% CI, 1.588-20.276; p=0.008); in-field complete/partial response was a significant prognostic factor for better OS (HR, 0.116; 95% CI, 0.027-0.499; p=0.004). The most common site of first failure was the lungs (13/34 patients, 38.2%), followed by the liver (7/34 patients, 20.6%). No patients developed radiation-induced liver disease or pulmonary embolism during follow-up.
Combining RT and systemic therapy was safe and effective in treating patients with HCC with HVTT and IVCTT.
本研究评估了接受放疗（RT）联合全身治疗的肝细胞癌（HCC）合并肝静脉肿瘤血栓（HVTT）和/或下腔静脉肿瘤血栓（IVCTT）患者的临床结局。
在我们机构确定了接受RT的HCC合并HVTT和/或IVCTT患者。计划靶体积的处方剂量为30 - 65 Gy，大体肿瘤体积的处方剂量为40 - 65 Gy。如果患者有远处转移的高风险或已经发生远处转移，则同时使用靶向治疗和免疫检查点抑制剂。RT完成后，在1、3、6和12个月进行随访，此后每3至6个月进行一次随访。记录客观缓解率（ORR）、总生存期（OS）、无进展生存期（PFS）和毒性。
回顾性纳入了2016年1月至2021年9月期间的34例患者。大多数患者同时接受了靶向治疗（70.6%）和/或RT后治疗（79.4%）。靶区内ORR和疾病控制率分别为79.4%和97.1%。1年OS率为77.6%，2年OS率为36.3%（中位OS，15.8个月）。中位PFS和中位靶区内PFS分别为4.2个月和未达到。1年时PFS和靶区内PFS率分别为24.6%和79.2%，2年时分别为19.7%和72.0%。甲胎蛋白水平>1000 ng/mL是OS较差的显著预后因素（HR，5.674；95%CI，1.588 - 20.276；p = 0.008）；靶区内完全/部分缓解是OS较好的显著预后因素（HR，0.116；95%CI，0.027 - 0.499；p = 0.004）。首次失败最常见部位是肺（13/34例患者；38.2%）），其次是肝脏（7/34例患者，20.6%）。随访期间无患者发生放射性肝病或肺栓塞。
RT与全身治疗联合应用治疗HCC合并HVTT和IVCTT患者是安全有效的。
