Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement.
OBJECTIVE
The aim of this study was to examine the effectiveness and toxicity of radiation therapy in combination with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with extensive portal vein tumor thrombus (PVTT).


METHODS
The combined therapy was performed in 24 HCC patients with extensive PVTT. External radiation targeted for PVTT (50 Gy in 2 Gy fractions) was performed in combination with repetitive TACE for intralobar lesions using 30-60 mg epirubicin every 3 months, and associations of the following variables with the survival rate were evaluated: gender, age, viral etiology, Child's class, performance status, extrahepatic metastasis, size and number of HCC, and location of PVTT.


RESULTS
The local response confined to PVTT was complete response (CR) in four patients, partial response (PR) in eight patients, no change (NC) in eight patients, and progressive disease (PD) in four patients. By using the stepwise Cox's regression analysis, only Child's class was associated with the survival rate. The survival rates after 1 and 2 years were 73 and 21% in Child's A, 10 and 0% in Child B or C, and 61 and 21% in patients in whom the local response was CR or PR, and 19 and 9% in those in whom the local response was NC or PD, respectively. By using the multiple logistic regression analysis, Child's class was the only factor associated with the local response (P = 0.006).


CONCLUSIONS
The combined therapy is feasible and may be useful to reverse PVTT in patients with good hepatic function reserve.
Tazawa
J
J
Departments of Internal Medicine and; Radiology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan. tzw-j@mwb.biglobe.ne.jp
Maeda
M
M
Sakai
Y
Y
Yamane
M
M
Ohbayashi
H
H
Kakinuma
S
S
Miyasaka
Y
Y
Nagayama
K
K
Enomoto
N
N
Sato
C
C
D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011169:Portal Vein; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis
D000970:Antineoplastic Agents