Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Three-dimensional conformal radiotherapy for portal vein tumor thrombosis alone in advanced hepatocellular carcinoma

  • Lee, Ju Hye (Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Kim, Dong Hyun (Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Ki, Yong Kan (Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Nam, Ji Ho (Department of Radiation Oncology, Pusan National University Yangsan Hospital) ;
  • Heo, Jeong (Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Woo, Hyun Young (Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Kim, Dong Won (Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Kim, Won Taek (Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine)
  • Received : 2014.06.11
  • Accepted : 2014.08.18
  • Published : 2014.09.30
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Abstract

Purpose: We sought to evaluate the clinical outcomes of 3-dimensional conformal radiation therapy (3D-CRT) for portal vein tumor thrombosis (PVTT) alone in patients with advanced hepatocellular carcinoma. Materials and Methods: We retrospectively analyzed data on 46 patients who received 3D-CRT for PVTT alone between June 2002 and December 2011. Response was evaluated following the Response Evaluation Criteria in Solid Tumors. Prognostic factors and 1-year survival rates were compared between responders and non-responders. Results: Thirty-seven patients (80.4%) had category B Child-Pugh scores. The Eastern Cooperative Oncology Group performance status score was 2 in 20 patients. Thirty patients (65.2%) had main or bilateral PVTT. The median irradiation dose was 50 Gy (range, 35 to 60 Gy) and the daily median dose was 2 Gy (range, 2.0 to 2.5 Gy). PVTT response was classified as complete response in 3 patients (6.5%), partial response in 12 (26.1%), stable disease in 19 (41.3%), and progressive disease in 12 (26.1%). There were 2 cases of grade 3 toxicities during or 3 months after radiotherapy. Twelve patients in the responder group (15 patients) received at least 50 Gy irradiation, but about 84% of patients in the non-responder group received less than 50 Gy. The 1-year survival rate was 66.8% in responders and 27.4% in non-responders constituting a statistically significant difference (p = 0.008). Conclusion: Conformal radiotherapy for PVTT alone could be chosen as a palliative treatment modality in patients with unfavorable conditions (liver, patient, or tumor factors). However, more than 50 Gy of radiation may be required.

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References

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