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Combined Chemoembolization and Radiotherapy Versus Chemoembolization Alone for Hepatocellular Carcinoma Invading the Hepatic Vein or Inferior Vena Cava

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the efficacy and safety of transarterial chemoembolization (TACE) plus radiotherapy compared with TACE alone for patients with hepatocellular carcinoma (HCC) invading the hepatic vein (HV) or inferior vena cava (IVC).

Materials and Methods

Data from 79 patients who underwent TACE plus radiotherapy as a first-line treatment for non-metastatic HCC invading the HV or IVC between 2006 and 2018 were retrospectively evaluated. These findings were compared with data from a historical control group, consisting of 80 patients who received TACE alone between 2000 and 2006.

Results

Baseline characteristics were similar in both groups. Median progression-free survival (PFS) (8.1 vs. 4.4 months, P = 0.003) and overall survival (OS) (18.3 vs. 9.5 months, P = 0.002) were longer in the TACE plus radiotherapy than in the TACE alone group. Multivariate analysis showed that PFS and OS were significantly associated with treatment type. Subgroup analyses found that TACE plus radiotherapy showed better OS than TACE alone in patients with Child–Pugh class A, maximal tumor size < 9 cm, tumor number < 4, serum alpha-fetoprotein level ≥ 400 ng/mL, infiltrative tumor, IVC tumor thrombus, and combined portal vein invasion. The major complication rates were similar between the TACE plus radiotherapy (16.5%) and the TACE alone (13.8%) group (P = 0.664)

Conclusion

Both TACE plus radiotherapy and TACE alone showed similar safety in treating non-metastatic HCC invading the HV or IVC. TACE plus radiotherapy seems effective to prolong OS and PFS compared to TACE alone in this specific patient group.

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Abbreviations

HCC:

Hepatocellular carcinoma

PVTT:

Portal vein tumor thrombosis

HVTT:

Hepatic vein tumor thrombus

OS:

Overall survival

BCLC:

Barcelona Clinical Liver Cancer

HV:

Hepatic vein

IVC:

Inferior vena cava

IVCTT:

Inferior vena cava tumor thrombus

TACE:

Transarterial chemoembolization

RT:

Radiotherapy

RA:

Right atrium

ECOG:

Eastern Cooperative Oncology Group

GTV:

Gross tumor volume

ITV:

Internal target volume

PTV:

Planning target volume

mRECIST:

Modified Response Evaluation Criteria in Solid Tumors

CR:

Complete response

PR:

Partial response

SD:

Stable disease

PD:

Progressive disease

PFS:

Progression-free survival

CIRSE:

Cardiovascular and Interventional Radiological Society of Europe

AFP:

α-Fetoprotein

IQR:

Interquartile range

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

SD:

Standard difference

n:

Number

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Funding

This study was not supported by any funding.

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Author notes

  1. Ibrahim Alrashidi and Hee Ho Chu have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine , 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea

    Ibrahim Alrashidi, Hee Ho Chu, Jin Hyoung Kim, Pyeong Hwa Kim, Dong Il Gwon & Heung-Kyu Ko

  2. Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea

    Ju Hyun Shim

  3. Department of Radiation Oncology, Asan Medical Center, Asan Liver Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea

    Sang Min Yoon

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  1. Ibrahim Alrashidi
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Correspondence to Jin Hyoung Kim.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This study was reviewed and approved by the Institutional Review Board of Asan Medical Center (IRB No. 2020-1058).

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Alrashidi, I., Chu, H.H., Kim, J.H. et al. Combined Chemoembolization and Radiotherapy Versus Chemoembolization Alone for Hepatocellular Carcinoma Invading the Hepatic Vein or Inferior Vena Cava. Cardiovasc Intervent Radiol 44, 1060–1069 (2021). https://doi.org/10.1007/s00270-021-02815-3

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