Radiation therapy for portal venous invasion by hepatocellular carcinoma.
OBJECTIVE
To clarify the efficacy and safety of three-dimensional conformal radiotherapy (3-D CRT) for this disease and to specify patient subgroups suitable for this treatment.


METHODS
Fifty-two patients with HCC received PVI-targeted radiation therapy from January 1995 through December 2003. Portal venous invasion (PVI) was found in the second or lower order branches of the portal vein in 6 patients, in the first branch in 24 patients and in the main trunk in 22 patients. Child classifications of liver function before radiation therapy were A, B, and C for 19, 24 and 2 patients, respectively. All patients received three-dimensional conformal radiotherapy with a total dose ranging from 39 to 60 Gy (57.0 Gy in average).


RESULTS
Overall survival rates at 1, 2, 3, 4, and 5 years were 45.1%, 25.3%, 15.2%, 10.1%, and 5.1%, respectively. Univariate analysis revealed that Child status, the number of tumor foci, tumor type, transcatheter arterial embolization (TAE) after radiation therapy were statistically significant prognostic factors. Multivariate analysis showed that the number of tumor foci and TAE after radiation therapy were statistically significant.


CONCLUSIONS
The results of this study strongly suggest the efficacy of 3-D CRT as treatment for PVI in HCC. 3-D CRT is recommended in combination with post-radiation TAE for PVI of HCC with 5 tumor foci or less in the liver and with Child A liver function.
Nakagawa
Keiichi
K
Department of Radiology, Faculty of Medicine, University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan. nakagawa-rad@umin.ac.jp
Yamashita
Hideomi
H
Shiraishi
Kenshiro
K
Nakamura
Naoki
N
Tago
Masao
M
Igaki
Hiroshi
H
Hosoi
Yoshio
Y
Shiina
Shuichiro
S
Omata
Masao
M
Makuuchi
Masatoshi
M
Ohtomo
Kuni
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011169:Portal Vein / Q000473:pathology; D011172:Portography; D020266:Radiotherapy, Conformal; D015996:Survival Rate