Three-dimensional conformal radiotherapy for portal vein thrombosis of hepatocellular carcinoma

Abstract

Background: Portal vein thrombosis (PVT) is a common complication in patients with advanced-stage hepatocellular carcinoma (HCC). The authors evaluated the impact of radiotherapy (RT) for PVT of HCC and analyzed the dose-response relation between RT and PVT.

Methods: Between March 1995 and December 2003, 59 patients diagnosed as HCC with PVT were included. The inclusion criteria were unresectable tumor with thrombosis in the main or first branch of the portal vein, liver function of Child-Pugh Class A or B, and an Eastern Cooperative Oncology Group performance status score of 0-2. The median age of the patients was 57 years (range, 36-78 years). A daily dose ranging from 2 to 3 gray (Gy) was administered using 6 or 10-megavolt (MV) X-rays, at 5 fractions a week, to deliver a total dose range of 30-54 Gy, which was a biologic effective dose of 39-70.2 Gy(10) with an alpha/beta ratio of 10.

Results: Follow-up computed tomography scans showed a complete response (CR) in 4 of 59 patients (6.8%), a partial response (PR) in 23 patients (39.0%), no response (NR) in 28 patients (47.5%), and progressive disease (PD) in 4 patients (6.8%). The mean RT doses in the responders (CR and PR) and nonresponders (NR and PD) were 59.6 +/- 5.6 Gy(10) and 54.9 +/- 8.5 Gy(10), respectively (P = 0.036). The response rates in patients receiving < 58 Gy(10) and > or = 58 Gy(10) were 20% and 54.6%, respectively (P = 0.034). The median survival duration and the 1-year and 2-year survival rates in the responders were 10.7 months, 40.7%, and 20.7%, respectively, and were 5.3 months, 25.0%, and 4.7%, respectively, in the nonresponders (P = 0.050).

Conclusions: RT induced a 45.8% objective response rate for PVT in patients with HCC. A dose-response relation was found to exist between the RT dose and PVT response. These results suggested that RT may be a treatment option for PVT in patients with HCC and that an RT dose > or = 58 Gy(10) should be recommended.