title: Three-dimensional conformal radiotherapy for portal vein tumor thrombosis alone in advanced hepatocellular carcinoma.
abstract: OBJECTIVE
  We sought to evaluate the clinical outcomes of 3-dimensional conformal radiation therapy (3D-CRT) for portal vein tumor thrombosis (PVTT) alone in patients with advanced hepatocellular carcinoma.
  
  
  METHODS
  We retrospectively analyzed data on 46 patients who received 3D-CRT for PVTT alone between June 2002 and December 2011. Response was evaluated following the Response Evaluation Criteria in Solid Tumors. Prognostic factors and 1-year survival rates were compared between responders and non-responders.
  
  
  RESULTS
  Thirty-seven patients (80.4%) had category B Child-Pugh scores. The Eastern Cooperative Oncology Group performance status score was 2 in 20 patients. Thirty patients (65.2%) had main or bilateral PVTT. The median irradiation dose was 50 Gy (range, 35 to 60 Gy) and the daily median dose was 2 Gy (range, 2.0 to 2.5 Gy). PVTT response was classified as complete response in 3 patients (6.5%), partial response in 12 (26.1%), stable disease in 19 (41.3%), and progressive disease in 12 (26.1%). There were 2 cases of grade 3 toxicities during or 3 months after radiotherapy. Twelve patients in the responder group (15 patients) received at least 50 Gy irradiation, but about 84% of patients in the non-responder group received less than 50 Gy. The 1-year survival rate was 66.8% in responders and 27.4% in non-responders constituting a statistically significant difference (p = 0.008).
  
  
  CONCLUSIONS
  Conformal radiotherapy for PVTT alone could be chosen as a palliative treatment modality in patients with unfavorable conditions (liver, patient, or tumor factors). However, more than 50 Gy of radiation may be required.
authors.affiliation: Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. ; Department of Radiation Oncology, Medical Research Institute, Pusan National University, Busan, Korea.
authors.forename: Ju Hye
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. ; Department of Radiation Oncology, Medical Research Institute, Pusan National University, Busan, Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. ; Department of Radiation Oncology, Medical Research Institute, Pusan National University, Busan, Korea.
authors.forename: Yong Kan
authors.initials: YK
authors.lastname: Ki
authors.affiliation: Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Ji Ho
authors.initials: JH
authors.lastname: Nam
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Jeong
authors.initials: J
authors.lastname: Heo
authors.affiliation: Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Woo
authors.affiliation: Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. ; Department of Radiation Oncology, Medical Research Institute, Pusan National University, Busan, Korea.
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. ; Department of Radiation Oncology, Medical Research Institute, Pusan National University, Busan, Korea.
authors.forename: Won Taek
authors.initials: WT
authors.lastname: Kim
keywords: Hepatocellular carcinoma; Portal vein; Radiotherapy