title: Hepatocellular carcinoma with main portal vein tumor thrombus: treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolization.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT) is often associated with poor prognosis. We retrospectively assessed the effectiveness of percutaneous transhepatic portal vein stenting and transarterial chemoembolization (PTPVS-TACE) combined with or without 3-dimensional conformal radiotherapy (3-DCRT) for HCC with MPVTT.
  
  
  METHODS
  Forty-five patients with HCC complicated by MPVTT were treated with PTPVS-TACE. Among them, 16 patients (group A) received 3-DCRT with 30-60Gy as daily 2Gy fractions. The remaining 29 patients (group B) received no radiotherapy. The tumor responses, complications, stent patency rates, and cumulative survival rates were evaluated, and the Kaplan-Meier method and log-rank test were used for survival analysis.
  
  
  RESULTS
  No severe complications were associated with PTPVS-TACE and 3-DCRT. The objective response rate (CR and PR) was 35.6%. The 60-, 180-, and 360-day cumulative stent patency rates were 93.3%, 62.2%, and 34.6% in group A, and 58.6%, 21.7%, and 10.8% in group B, respectively, showing significant difference between the 2 groups (P<.01). The mean patency time was 475.20+/-136.97 and 199.58+/-61.40 days, respectively. The 60-, 180-, and 360-day cumulative survival rates were 93.8%, 81.3%, and 32.5%, respectively, for group A, 86.2%, 13.8%, and 6.9%, respectively, for group B. Significant statistical differences were detected between the 2 groups (P<.01).
  
  
  CONCLUSIONS
  These findings suggest that sequential therapy by PTPVS-TACE-3-DCRT is possibly an effective treatment modality for HCC complicated by main portal vein tumor thrombus.
authors.affiliation: Department of Radiology, Zhong Shan Hospital, Fudan University, Fenglin Road, Shanghai, China.
authors.forename: Xue-Bin
authors.initials: XB
authors.lastname: Zhang
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Wang
authors.forename: Zhi-Pin
authors.initials: ZP
authors.lastname: Yan
authors.forename: Sheng
authors.initials: S
authors.lastname: Qian
authors.forename: Shi-Suo
authors.initials: SS
authors.lastname: Du
authors.forename: Zhao-Chong
authors.initials: ZC
authors.lastname: Zeng
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000532:radiotherapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011169:Portal Vein / Q000601:surgery*; D020266:Radiotherapy, Conformal; D015607:Stents; D016019:Survival Analysis; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000150:complications* / Q000532:radiotherapy* / Q000601:surgery*