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World Journal of Surgery

, Volume 37, Issue 6, pp 1362–1370 | Cite as

Surgical Resection Versus Conformal Radiotherapy Combined With TACE for Resectable Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Comparative Study

  • Qing-he Tang
  • Ai-jun Li
  • Guang-ming Yang
  • Eric C.H. Lai
  • Wei-ping Zhou
  • Zhi-hao Jiang
  • Wan Yee Lau
  • Meng-chao Wu
Article

Abstract

Background

The aim of this study was to compare the results of surgical resection with three-dimensional conformal radiotherapy (3D-CRT) in the treatment of resectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Transarterial chemoembolization (TACE) was given to both groups of patients when possible.

Methods

A retrospective study of 371 patients with resectable HCC with PVTT was conducted in two tertiary referral centers. The treatment of choice for these patients in one center was surgical resection. In the other center it was 3D-CRT. In the radiotherapy group (RG, n = 185), patients received 3D-CRT to the tumor and PVTT for a total radiation dose of 30–52 Gy (median 40 Gy). In the surgical group (SG, n = 186), patients underwent surgical resection. TACE was applied after surgery or 3D-CRT and then was repeated every 4–6 weeks if the patient tolerated the treatment.

Results

The median survival was 12.3 months for RG and 10.0 months for SG. The 1-, 2-, and 3-year overall survivals were 51.6, 28.4, and 19.9 %, respectively, for RG and 40.1, 17.0, and 13.6 %, respectively, for SG (p = 0.029). Stepwise multivariate analysis showed that the extent of PVTT and mode of treatment were independent risk factors of overall survival. The most common cause of death after treatment was liver failure as a consequence of progressive intrahepatic disease.

Conclusions

3D-CRT gave better survival than surgical resection for HCC with PVTT.

Keywords

Overall Survival Portal Vein Liver Resection Tace Extrahepatic Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The study was supported by the Chinese Key Project for Infectious Diseases (2008ZX10002-018, 2008ZX10002-025) and the Science Fund for Creative Research Groups, NSFC, China (30921006).

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Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Qing-he Tang
    • 1
  • Ai-jun Li
    • 1
  • Guang-ming Yang
    • 3
  • Eric C.H. Lai
    • 1
    • 2
  • Wei-ping Zhou
    • 1
  • Zhi-hao Jiang
    • 3
  • Wan Yee Lau
    • 1
    • 2
  • Meng-chao Wu
    • 1
  1. 1.The Third Department of Hepatic SurgeryEastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityShanghaiChina
  2. 2.Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales HospitalShatin, Hong Kong SARChina
  3. 3.Navy No. 411 Hospital of ShanghaiShanghaiChina

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