Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area.
This nationwide, multicenter study investigated treatment outcomes as well as the optimal radiotherapeutic strategy in patients with hepatocellular carcinoma (HCC) and portal vein tumour thrombosis (PVTT).



We retrospectively reviewed the records of 985 patients who received radiotherapy (RT) for PVTT. The median equivalent RT dose was 48.75 Gy. Combined treatment, defined as liver-directed treatments performed within a month of RT, was administered to 657 patients (66.7%). The PVTT and primary tumour were irradiated in 413 patients (41.9%), and PVTT only was targeted in 572 patients (58.1%).



The response rate of the PVTT was 51.8%, and RT responders had a significantly longer survival than non-responders (15.2 vs. 6.9 months). Equivalent RT dose and combined treatment predicted response of PVTT. The median overall survival (OS) was 10.2 months. Multivariate analysis revealed the equivalent RT dose ˃45 Gy and combined treatment as significant positive factors for OS. In the propensity score matching analysis, the combined treatment group had better OS than the no combined treatment group, whereas the OS of the PVTT + primary tumour group did not differ significantly from that of the PVTT only group.



The equivalent RT dose ˃45 Gy, given in combination with other treatments, provided better PVTT control and OS. The optimal RT volume is suggested for either PVTT + primary or PVTT only. Taken together, multimodal treatment with equivalent RT dose higher than 45 Gy is recommended for patients with HCC and PVTT.
Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Jung Ho
JH
Im
Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Sang Min
SM
Yoon
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.|Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
Hee Chul
HC
Park
Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Jong Hoon
JH
Kim
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.|Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
Jeong Il
JI
Yu
Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Tae Hyun
TH
Kim
Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Jun Won
JW
Kim
Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
Taek-Keun
TK
Nam
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
Kyubo
K
Kim
Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Hong Seok
HS
Jang
Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
Jin Hee
JH
Kim
Department of Radiation Oncology, Korea Institute Radiological & Medical Sciences, Seoul, Korea.
Mi-Sook
MS
Kim
Department of Radiation Oncology, Ansan Hospital, Korea University Medical Center, Ansan, Korea.
Won Sup
WS
Yoon
Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
Inkyung
I
Jung
Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Jinsil
J
Seong
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007723:Korea; D008113:Liver Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein / Q000473:pathology; D057216:Propensity Score; D011829:Radiation Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000532:radiotherapy*; D055815:Young Adult
combined modality therapy; hepatocellular carcinoma; portal vein tumour thrombosis; radiotherapy; radiotherapy dosage