[Efficacy of transarterial chemolipiodolization with or without 3-dimensional conformal radiotherapy for huge HCC with portal vein tumor thrombosis].
OBJECTIVE
The treatment efficacy for advanced hepatocellular carcinoma is poor. This study examined the efficacy and toxicity of 3-dimensional conformal radiotherapy (3D-CRT) in combination with transarterial chemolipiodolization (TACL) for a huge hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).


METHODS
From March 2001 to November 2004, 49 patients with advanced HCC with PVTT (size>8 cm, modified UICC stage IVa) were enrolled in this retrospective study. Twenty two patients underwent more than 2 cycles of TACL (adriamycin 50 mg/m(2), cisplatin 60 mg/m(2), 5-fluorouracil 200 mg/m(2) every 4-6 weeks) without 3D-CRT, while 27 patients underwent consecutive TACL with 3D-CRT (40-45 Gy for 4-5 weeks) that was started one week after the 1st TACL. The response was assessed by a computed tomography (CT) and the serum alpha-fetoprotein (AFP) level at 1-2 month intervals.


RESULTS
The objective response rates in the TACL group and TACL with 3D-CRT group were 18% and 48% at 3 months (P=0.051), and 10.5% and 42% at 6 months (P=0.024) respectively. The median survival time was 13 months and 13.5 months in TACL and TACL with 3D-CRT groups, respectively (P=0.502). The treatment response was better in the TACL with 3D-CRT group but there was no significant difference in survival between the two groups. Most toxicities in the two groups were mild, not exceeding grade 1 according to the WHO criteria.


CONCLUSIONS
For patients with a huge HCC with PVTT, TACL with 3D-CRT achieved some meaningful clinical benefit. Prospective controlled trials will be needed to confirm the real benefit of TACL combined with 3D-CRT.
You
Chan Ran
CR
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Jang
Jeong Won
JW
Kang
Seok Hui
SH
Bae
Si Hyun
SH
Choi
Jong Young
JY
Yoon
Seung Kew
SK
Choi
Ihl Bhong
IB
Lee
Dong Hoon
DH
Chun
Ho Jong
HJ
Choi
Byung Gil
BG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000532:radiotherapy / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003131:Combined Modality Therapy; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D016019:Survival Analysis; D020246:Venous Thrombosis / Q000209:etiology / Q000532:radiotherapy / Q000628:therapy*