Proton-beam therapy for hepatocellular carcinoma associated with portal vein tumor thrombosis.
OBJECTIVE
The prognosis of patients with advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is extremely poor, as effective treatment options are limited. The authors performed a retrospective review to evaluate the efficacy of proton-beam therapy (PBT) for patients presenting with PVTT in the setting of HCC.


METHODS
Between February 1991 and September 2005, 35 patients with HCC and tumor thrombi in the main trunk or major branches of the portal vein presented for consideration of PBT. Their tumor sizes ranged from 25 mm to 130 mm (median, 60 mm). A median total dose of 72.6 GyE in 22 fractions was delivered over 31 days to a target volume that encompassed both the primary hepatic lesion and the PVTT.


RESULTS
32 patients were progression-free during a median follow-up period of 21 months (range, 2-88 months) and three patients experienced disease progression. Local progression-free survival rates were 46% at 2 years and 20% at 5 years, and the median local progression-free survival was 21 months. Acute toxicity > or = grade 3 was observed in three patients, and no patient experienced late toxicity > or = grade 3. None of the patients had to discontinue treatment as a result of toxicity.


CONCLUSIONS
PBT improved local control and significantly prolonged survival in HCC patients with PVTT.
Sugahara
Shinji
S
Department of Radiation Oncology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan. ssuga@pmrc.tsukuba.ac.jp
Nakayama
Hidetsugu
H
Fukuda
Kuniaki
K
Mizumoto
Masashi
M
Tokita
Mari
M
Abei
Masato
M
Shoda
Junichi
J
Matsuzaki
Yasushi
Y
Thono
Eriko
E
Tsuboi
Koji
K
Tokuuye
Koichi
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology / Q000528:radiation effects*; D011169:Portal Vein / Q000528:radiation effects*; D011379:Prognosis; D061766:Proton Therapy; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D011522:Protons
D011522:Protons