在乙肝流行区肝癌放射治疗策略与门静脉癌栓

StephenW

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.)
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    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.

StephenW

在乙肝流行区肝癌放射治疗策略与门静脉癌栓

    何戎IM1，†，旻Yoon2，†，希澈Park3,4，钟勋Kim2，郑某伊尔Yu3,4，太铉Kim5，君元Kim6，泽 - 瑾Nam7，Kyubo Kim8，洪锡Jang9，珍熙Kim10，米塾Kim11，赢得燮Yoon12，Inkyung Jung13 andJinsil Seong1，*

DOI：10.1111 / liv.13191

本文由版权保护。版权所有。

问题
封面图片的卷。 36问题7
肝国际

接受第（接受，未经编辑的文章在网上和可引用的公布。最终的编辑和记录的排版本将出现在未来。）
文章为1的比分altmetric

    放疗科，Severance医院，医学延世大学学院，首尔，韩国的1系
    放射肿瘤学，牙山肝病中心，峨山医学中心蔚山大学学院，首尔，韩国的2部
    放射肿瘤学，三星医学中心的成均馆大学学院，首尔，韩国的3系
    韩国成均馆大学医疗器械管理的4部和研究，SAIHST，首尔，韩国
    5中心肝癌，研究所和医院，国家癌症中心，高阳，韩国
    放射肿瘤学，江南Severance医院，医学延世大学学院，首尔，韩国的6系
    放射肿瘤学，全南大学医学院，光州，韩国的7系
    放射肿瘤学，医学的首尔国立大学，首尔，韩国的8部
    放射肿瘤学，首尔圣母医院，韩国天主教大学，首尔，韩国的9部
    放射肿瘤学，东山医学中心的启明大学，大邱，韩国的10部
    放射肿瘤学，韩国研究所放射学和医学科学，首尔，韩国的11部
    放疗科，安山医院，高丽大学医学中心，安山，韩国的12部
    生物统计学系13医学院，首尔，韩国的延世大学

    †这些作者同等贡献这项工作作为第一作者。

*通讯：Jinsil洪城，医学博士，博士
放射肿瘤学，延世癌症中心，延世大学健康系统，50-1延世-RO，西大门区，首尔120-752，韩国系。
电话：82-2-2228-8095;传真：82-2-2227-7823;电子邮件：[email protected]

    这篇文章已被接受发表，并接受全面的同行评审，但经过审稿，排版，分页和校对过程中，这可能会导致这个版本和记录的版本之间的差异一直没有。请引用这篇文章的DOI：10.1111 / liv.13191


关键词：

    肝癌;门静脉癌栓;放疗，放疗剂量;综合疗法

抽象
背景和目的

这项全国性的，多中心研究调查的治疗效果以及患者的肝细胞癌（HCC）和门静脉癌栓（PVTT）的最佳放疗策略。
方法

我们回顾性分析了谁门静脉癌栓接受放射治疗（RT）985例患者的记录。中位数相当于RT剂量为48.75戈瑞。联合治疗，其定义为一个月的RT内进行肝脏定向治疗，施用到657例（66.7％）。的PVTT和原发性肿瘤是在413名患者（41.9％）照射，和PVTT仅在572名患者（58.1％）的目标。
结果

在门静脉癌栓的有效率为51.8％，与RT应答者比无应答者（15.2个月对6.9个月）一个显著较长的生存。等效RT剂量和联合治疗门静脉癌栓预测的响应。中位总生存期（OS）为10.2个月。多变量分析显示等效剂量RT 45˃戈瑞和OS联合治疗为显著的积极因素。在倾向评分匹配分析，联合治疗组比不联合治疗组更好的操作系统，而门静脉癌栓+原发肿瘤组的操作系统并没有从该门静脉癌栓仅组显著不同。
结论

等效RT剂量˃45戈瑞，在与其他治疗组合给予，提供更好PVTT控制和操作系统。最佳RT体积建议的两种门静脉癌栓+主要或门静脉癌栓而已。综合来看，具有同等RT综合治疗剂量超过45戈瑞，建议患者肝癌门静脉癌栓和。

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