Surgical Resection Versus Conformal Radiotherapy Combined With TACE for Resectable Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Comparative Study
- 881 Downloads
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.
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.
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.
3D-CRT gave better survival than surgical resection for HCC with PVTT.
KeywordsOverall Survival Portal Vein Liver Resection Tace Extrahepatic Metastasis
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).
- 1.Lau WY (2000) Primary hepatocellular carcinoma. In: Blumgart LH, Fong Y (eds) Surgery of the liver and biliary tract vol II, 3rd edn. Saunders, London, pp 1423–1450Google Scholar
- 5.Lau WY, Lai EC, Yu SC (2008) Management of portal vein tumor thrombus. In: Lau WY (ed) Hepatocellular Carcinoma. World Scientific Publishing, Singapore, pp 739–760Google Scholar
- 6.Cheng SQ, Wu MC, Chen H et al (2007) Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein. Hepatogastroenterology 54:499–502Google Scholar
- 17.Yamada K, Izaki K, Sugimoto K et al (2003) Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 57:113–119PubMedCrossRefGoogle Scholar
- 26.Mornex F, Girard N, Beziat C et al (2006) Feasibility and efficacy of high-dose three-dimensional-conformal radiotherapy in cirrhotic patients with small-size hepatocellular carcinoma noneligible for curative therapies-mature results of the French Phase II RTF-1 trial. Int J Radiat Oncol Biol Phys 66:1152–1158PubMedCrossRefGoogle Scholar
- 36.Li Q, Wang J, Sun Y et al (2006) Efficacy of postoperative transarterial chemoembolization and portal vein chemotherapy for patients with hepatocellular carcinoma complicated by portal vein tumor thrombosis: a randomized study. World J Surg 30:2004–2011. doi: 10.1007/s00268-006-0271-6 PubMedCrossRefGoogle Scholar
- 42.Zhou J, Tang ZY, Wu ZQ et al (2006) Factors influencing survival in hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis after surgery, with special reference to time dependency: a single-center experience of 381 cases. Hepatogastroenterology 53:275–280PubMedGoogle Scholar