title: Three-dimensional conformal radiotherapy for portal vein thrombosis of hepatocellular carcinoma.
abstract: BACKGROUND
  Portal vein thrombosis (PVT) is a common complication in patients with advanced-stage hepatocellular carcinoma (HCC). The authors evaluated the impact of radiotherapy (RT) for PVT of HCC and analyzed the dose-response relation between RT and PVT.
  
  
  METHODS
  Between March 1995 and December 2003, 59 patients diagnosed as HCC with PVT were included. The inclusion criteria were unresectable tumor with thrombosis in the main or first branch of the portal vein, liver function of Child-Pugh Class A or B, and an Eastern Cooperative Oncology Group performance status score of 0-2. The median age of the patients was 57 years (range, 36-78 years). A daily dose ranging from 2 to 3 gray (Gy) was administered using 6 or 10-megavolt (MV) X-rays, at 5 fractions a week, to deliver a total dose range of 30-54 Gy, which was a biologic effective dose of 39-70.2 Gy(10) with an alpha/beta ratio of 10.
  
  
  RESULTS
  Follow-up computed tomography scans showed a complete response (CR) in 4 of 59 patients (6.8%), a partial response (PR) in 23 patients (39.0%), no response (NR) in 28 patients (47.5%), and progressive disease (PD) in 4 patients (6.8%). The mean RT doses in the responders (CR and PR) and nonresponders (NR and PD) were 59.6 +/- 5.6 Gy(10) and 54.9 +/- 8.5 Gy(10), respectively (P = 0.036). The response rates in patients receiving < 58 Gy(10) and > or = 58 Gy(10) were 20% and 54.6%, respectively (P = 0.034). The median survival duration and the 1-year and 2-year survival rates in the responders were 10.7 months, 40.7%, and 20.7%, respectively, and were 5.3 months, 25.0%, and 4.7%, respectively, in the nonresponders (P = 0.050).
  
  
  CONCLUSIONS
  RT induced a 45.8% objective response rate for PVT in patients with HCC. A dose-response relation was found to exist between the RT dose and PVT response. These results suggested that RT may be a treatment option for PVT in patients with HCC and that an RT dose > or = 58 Gy(10) should be recommended.
authors.affiliation: Research Institute and Hospital, National Cancer Center, Gyeonggi, Korea.
authors.forename: Dae Yong
authors.initials: DY
authors.lastname: Kim
authors.forename: Won
authors.initials: W
authors.lastname: Park
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Lim
authors.forename: Joon Hyoek
authors.initials: JH
authors.lastname: Lee
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Yoo
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
authors.forename: Kwang Cheol
authors.initials: KC
authors.lastname: Kho
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Ahn
authors.forename: Seung Jae
authors.initials: SJ
authors.lastname: Huh
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000532:radiotherapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011169:Portal Vein; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D015996:Survival Rate; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000532:radiotherapy*