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Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumor thrombosis in a hepatitis B endemic area
Jung Ho Im1,†, Sang Min Yoon2,†, Hee Chul Park3,4, Jong Hoon Kim2, Jeong Il Yu3,4, Tae Hyun Kim5, Jun Won Kim6, Taek-Keun Nam7, Kyubo Kim8, Hong Seok Jang9, Jin Hee Kim10, Mi-Sook Kim11, Won Sup Yoon12, Inkyung Jung13 andJinsil Seong1,*
DOI: 10.1111/liv.13191
This article is protected by copyright. All rights reserved.
Issue
Cover image for Vol. 36 Issue 7
Liver International
Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)
Article has an altmetric score of 1
1 Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
2 Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
3 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
4 Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
5 Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
6 Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
7 Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
8 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
9 Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
10 Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
11 Department of Radiation Oncology, Korea Institute Radiological & Medical Sciences, Seoul, Republic of Korea
12 Department of Radiation Oncology, Ansan Hospital, Korea University Medical Center, Ansan, Republic of Korea
13 Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea
† These authors contributed equally to this work as first authors.
* Correspondence: Jinsil Seong, M.D., Ph.D.
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Tel: 82-2-2228-8095; Fax: 82-2-2227-7823; Email: [email protected]
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/liv.13191
Keywords:
hepatocellular carcinoma;portal vein tumor thrombosis;radiotherapy;radiotherapy dosage;combined modality therapy
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 tumor 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 tumor 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 months 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, while the OS of the PVTT + primary tumor 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.
This article is protected by copyright. All rights reserved.
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