Japanese Journal of Clinical Oncology 31:147-152 (2001)
© 2001 Foundation for Promotion of Cancer Research
Pilot Study of Local Radiotherapy for Portal Vein Tumor Thrombus in Patients with Unresectable Hepatocellular Carcinoma
Department of Radiology, Kobe University School of Medicine, Kobe, Japan
Background: Patients suffering from hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) generally have a poor prognosis. We therefore conducted a prospective pilot trial of combined transcatheter arterial chemoembolization (TACE) and local radiotherapy (RT) for PVTT in unresectable HCC. The aim of the study was to investigate the efficacy and toxicity of this preliminary trial regime and to explore RT guidelines for cirrhosis.
Methods: Eight patients with unresectable HCC accompanied by first branch PVTT were entered into the study from February 1998 to December 1999. TACE was performed using Lipiodol, epirubicin hydrochloride and mytomycin followed by gelatin sponge cubes. RT was started 10–14 days following TACE. A total delivered dose of 60 Gy was given as daily 2 Gy fractions, with the clinical target volume defined as PVTT only. We observed a relationship between deterioration of liver function and the percent volume of the total liver receiving a dose exceeding 30 Gy (V30).
Results: An objective response was observed in three of the eight patients. However, on follow-up angiograms the protrusion of PVTT into the main portal trunk was decreased in all cases. Deterioration of liver function was observed in all patients with V30 >40%.
Conclusion: It is possible that this combined therapy prevents PVTT from spreading to the main trunk and that indicates a further benefit of TACE. Our results indicate that V30 constitutes a predictive test for the development of liver failure. More detailed evaluations of liver function and determination of the safe irradiation volume are necessary.
+ For reprints and all correspondence: Kazunari Yamada, Kobe University School of Medicine, 7–5–2 Kusunokicho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. E-mail: yamadaka@med.kobe-u.ac.jp
Abbreviations: HCC, hepatocellular carcinoma; PVTT, portal vein tumor thrombus; TACE, transcatheter arterial chemoembolization; RT, radiation therapy; V30, the percent volume of the total liver exceeding a dose of 30 Gy; CTV, clinical target volume; PTV, planning target volume; 3D-CRT, 3D conformal radiation therapy; DVH, dose–volume histogram; NTCP, normal tissue complication probability
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