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Abstract

BACKGROUND & AIMS:

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).

METHODS:

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%).

RESULTS:

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.

CONCLUSION:

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.

Author information​​

Im JH1, Yoon SM2, Park HC3,4, Kim JH2, Yu JI3,4, Kim TH5, Kim JW6, Nam TK7, Kim K8, Jang HS9, Kim JH10, Kim MS11, Yoon WS12, Jung I13, Seong J1.

1Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

2Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

3Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

4Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.

5Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

6Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

7Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.

8Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.

9Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

10Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

11Department of Radiation Oncology, Korea Institute Radiological & Medical Sciences, Seoul, Korea.

12Department of Radiation Oncology, Ansan Hospital, Korea University Medical Center, Ansan, Korea.

13Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.