title: Effectiveness of stereotactic body radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombosis.
abstract: BACKGROUND
  To report the feasibility, efficacy, and toxicity of stereotactic body radiotherapy (SBRT) for the treatment of portal vein tumor thrombosis (PVTT) and/or inferior vena cava tumor thrombosis (IVCTT) in patients with advanced hepatocellular carcinoma (HCC).
  
  
  METHODS
  Forty-one patients treated with SBRT using volumetric modulated arc therapy (VMAT) for HCC with PVTT/IVCTT between July 2010 and May 2012 were analyzed. Of these, 33 had PVTT and 8 had IVCTT. SBRT was designed to target the tumor thrombosis and deliver a median total dose of 36 Gy (range, 30-48 Gy) in six fractions during two weeks.
  
  
  RESULTS
  The median follow-up was 10.0 months. At the time of analysis, 15 (36.6%) achieved complete response, 16 (39.0%) achieved partial response, 7 (17.1%) patients were stable, and three (7.3%) patients showed progressive disease. No treatment-related Grade 4/5 toxicity was seen within three months after SBRT. One patient had Grade 3 elevation of bilirubin. The one-year overall survival rate was 50.3%, with a median survival of 13.0 months. The only independent predictive factor associated with better survival was response to radiotherapy.
  
  
  CONCLUSIONS
  VMAT-based SBRT is a safe and effective treatment option for PVTT/IVCTT in HCC. Prospective randomized controlled trials are warranted to validate the role of SBRT in these patients.
authors.affiliation: State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: Mian
authors.initials: M
authors.lastname: Xi
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Lei
authors.initials: L
authors.lastname: Zhao
authors.forename: Qiao-Qiao
authors.initials: QQ
authors.lastname: Li
authors.forename: Su-Ping
authors.initials: SP
authors.lastname: Guo
authors.forename: Zi-Zhen
authors.initials: ZZ
authors.lastname: Feng
authors.forename: Xiao-Wu
authors.initials: XW
authors.lastname: Deng
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Huang
authors.forename: Meng-Zhong
authors.initials: MZ
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D004307:Dose-Response Relationship, Radiation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D011874:Radiometry; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012449:Safety; D016019:Survival Analysis; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*; D020246:Venous Thrombosis / Q000150:complications* / Q000601:surgery*