Japanese Journal of Clinical Oncology Advance Access originally published online on April 13, 2006
Japanese Journal of Clinical Oncology 2006 36(4):212-217; doi:10.1093/jjco/hyl006
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© 2006 Foundation for Promotion of Cancer Research
Treatment of Portal Vein Tumor Thrombosis of Hepatoma Patients with Either Stereotactic Radiotherapy or Three-Dimensional Conformal Radiotherapy
Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
For reprints and all correspondence: Chun-Shu Lin, Department of Radiation Oncology, Tri-Service General Hospital, 325 Section 2 Cheng-Kong Rd., Nei-Hu 11490, Taipei, Taiwan, ROC; E-mail: bookslin.tw{at}yahoo.com.tw
Received October 25, 2005; accepted January 15, 2006
Background: Patients with hepatocellular carcinoma (HCC) often have unresectable tumors. Transcatheter arterial chemoembolization (TACE) is one of the limited alternative treatments that can prolong these patients' survival. However, the presence of portal vein tumor thrombosis (PVTT) is a contraindication for TACE and, therefore, HCC patients with PVTT would be depleted of the advantage of TACE. The purpose of this study was to analyze the recanalization rate of thrombosed portal vein and treatment toxicities after stereotactic radiotherapy (SRT) or three-dimensional conformal radiotherapy (3DCRT).
Methods: From March 2002 to November 2004, 43 patients were enrolled in this prospective study. Twenty-two patients were in the SRT group and 21 in the 3DCRT group. For SRT, 3 Gy per fraction, 3 fractions per week, was given to a total dose of 45 Gy. For 3DCRT, a daily dose of 1.8 Gy, 5 fractions per week, was given to a total dose of 45 Gy.
Results: Of the 43 patients, 16 completed the planned radiotherapy. Eventually, 14 patients received evaluation for portal vein recanalization, 8 in the SRT and 6 in the 3DCRT group, respectively. For all patients, the crude response rate was 26%. For 14 evaluable patients, the crude response rate was 79%. It was 75% in the SRT group and 83% in the 3DCRT group (P = 0.71). The median survival time was 6.0 and 6.7 months for the SRT and 3DCRT group, respectively (P = 0.911).
Conclusions: Image-based radiotherapy, either SRT or 3DCRT, can recanalize the PVTT in unresectable HCC patients. Responders also had better 1 year and 2 year survivals. A more strict patient selection criterion may maximize the potential benefits of radiotherapy for hepatoma patients with PVTT.
Key Words: stereotactic radiotherapy • three-dimensional conformal radiotherapy • portal vein tumor thrombosis • hepatocellular carcinoma • hepatoma
Abbreviations: AFP, alpha-fetoprotein • CR, complete response • 3DCRT, 3-dimensional conformal radiotherapy • HCC, hepatocellular carcinoma • PR, partial response • PD, progressive disease • SD, stable disease • SRT, stereotactic radiotherapy • TACE, transcatheter arterial chemoembolization.
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