title: Surgical resection versus conformal radiotherapy combined with TACE for resectable hepatocellular carcinoma with portal vein tumor thrombus: a comparative study.
abstract: BACKGROUND
  The aim of this study was to compare the results of surgical resection with three-dimensional conformal radiotherapy (3D-CRT) in the treatment of resectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Transarterial chemoembolization (TACE) was given to both groups of patients when possible.
  
  
  METHODS
  A retrospective study of 371 patients with resectable HCC with PVTT was conducted in two tertiary referral centers. The treatment of choice for these patients in one center was surgical resection. In the other center it was 3D-CRT. In the radiotherapy group (RG, n = 185), patients received 3D-CRT to the tumor and PVTT for a total radiation dose of 30-52 Gy (median 40 Gy). In the surgical group (SG, n = 186), patients underwent surgical resection. TACE was applied after surgery or 3D-CRT and then was repeated every 4-6 weeks if the patient tolerated the treatment.
  
  
  RESULTS
  The median survival was 12.3 months for RG and 10.0 months for SG. The 1-, 2-, and 3-year overall survivals were 51.6, 28.4, and 19.9 %, respectively, for RG and 40.1, 17.0, and 13.6 %, respectively, for SG (p = 0.029). Stepwise multivariate analysis showed that the extent of PVTT and mode of treatment were independent risk factors of overall survival. The most common cause of death after treatment was liver failure as a consequence of progressive intrahepatic disease.
  
  
  CONCLUSIONS
  3D-CRT gave better survival than surgical resection for HCC with PVTT.
authors: The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China.
authors: Qing-he
authors: QH
authors: Tang
authors: Ai-jun
authors: AJ
authors: Li
authors: Guang-ming
authors: GM
authors: Yang
authors: Eric C H
authors: EC
authors: Lai
authors: Wei-ping
authors: WP
authors: Zhou
authors: Zhi-hao
authors: ZH
authors: Jiang
authors: Wan Yee
authors: WY
authors: Lau
authors: Meng-chao
authors: MC
authors: Wu
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D011829:Radiation Dosage; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D015996:Survival Rate; D013927:Thrombosis / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome