title: Radiotherapy for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels: efficacy and outcomes.
abstract: OBJECTIVE
  To examine the efficacy and outcomes of radiotherapy (RT) in patients who have hepatocellular carcinoma with invasion to intrahepatic large vessels (IHLVs).
  
  
  METHODS
  Sixty-seven patients who had advanced hepatocellular carcinoma with invasion to IHLVs received three-dimensional conformal RT. IHLV invasion was associated with portal venous tumor thrombosis in 40 patients, tumor thrombosis involving the hepatic vein in 17, and both findings in 10. A daily radiation dose of 1.8-2 Gy was administered using 6 or 10 MV X-rays to deliver a total dose of 30-56 Gy.
  
  
  RESULTS
  The overall objective response rate (complete response plus partial response) was 45% (n = 30). The median survival time was 13.7 months in the responder group and 5.9 months in the nonresponder group. An objective response was observed in 28 (56%) of 50 patients with Child-Pugh (C-P) class A and in 2 (12%) of 17 patients with C-P class B. Hepatic function of C-P class A was an independent factor for both RT responder and overall survival on Cox regression analysis (hazard ratio = 9.5, 95% confidence interval = 1.97-46.2, P = 0.005; and hazard ratio = 0.39, 95% confidence interval = 0.2-0.77, P = 0.007, respectively).
  
  
  CONCLUSIONS
  RT is an effective treatment option without serious adverse events. RT should be considered for the patients with better hepatic function who have invasion to IHLVs.
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Takahide
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Shouko
authors.initials: S
authors.lastname: Komori
authors.forename: Hisashi
authors.initials: H
authors.lastname: Hidaka
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okuwaki
authors.forename: Juichi
authors.initials: J
authors.lastname: Takada
authors.forename: Masaaki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Minamino
authors.forename: Hajime
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Kokubu
authors.forename: Kazushige
authors.initials: K
authors.lastname: Hayakawa
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006503:Hepatic Veins / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011169:Portal Vein / Q000473:pathology*; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D015996:Survival Rate
keywords: hepatic venous tumor thrombosis; hepatocellular carcinoma; intrahepatic large vessels; portal venous tumor thrombosis; radiotherapy