title: Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma.
abstract: OBJECTIVE
  We conducted a prospective trial of combined transarterial chemoembolization (TACE) and three-dimensional conformal radiotherapy (3D-CRT) for portal vein tumor thrombus (PVTT) in unresectable hepatocellular carcinoma (HCC). The aim of the present study was to investigate the efficacy and toxicity of this trial regime.
  
  
  METHODS
  Patients with unresectable HCC complicated with tumor thrombus in the first branch of portal vein were selected as eligible for this study. TACE was performed using Lipiodol, epirubicin hydrochloride, and mitomycin, followed by gelatin sponge cubes. The 3D-CRT was performed targeting the clinical target volume (CTV) defined as PVTT only to a total dose of 60 Gy using 10-MV accelerator.
  
  
  RESULTS
  A total of 19 patients were enrolled in this study. Survival rates at 1 and 2 years were 40.6% and 10.2%, respectively. The median survival time was 7.0 months. An objective response was observed in 11 of 19 cases (57.9%). Recanalization of the first portal branches was not observed; however, the protrusion of PVTT into the main portal trunk decreased in all cases. Growth of intrahepatic metastasis outside the 3D-CRT field was observed in 12 cases (63%). Deterioration of the Child-Pugh Score was observed in 5 of 6 cases with the percent volume of the total liver receiving a dose exceeding 30 Gy (V(30)) > or =40%, vs. 2 of 13 cases with a V(30) <40% (p < 0.01).
  
  
  CONCLUSIONS
  This combined therapy was feasible. Our results indicate that V(30) was a predictive test for deterioration of liver function. Further investigation of treatment modalities is needed to prevent the growth of intrahepatic metastasis.
authors.affiliation: Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan. yamadaka@tenriyorozu-hp.or.jp
authors.forename: Kazunari
authors.initials: K
authors.lastname: Yamada
authors.forename: Kenta
authors.initials: K
authors.lastname: Izaki
authors.forename: Koji
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mayahara
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Morita
authors.forename: Eisaku
authors.initials: E
authors.lastname: Yoden
authors.forename: Shinichi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Toshinori
authors.initials: T
authors.lastname: Soejima
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura
mesh_terms: D000368:Aged; D006502:Budd-Chiari Syndrome / Q000209:etiology / Q000532:radiotherapy / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000532:radiotherapy / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents