The response of thrombosis in the portal vein or hepatic vein in hepatocellular carcinoma to radiation therapy

Abstract

Purpose: The purpose of current study is to evaluate the response of the patients with portal vein thrombosis (PVT) or hepatic vein thrombosis (HVT) in hepatocellular carcinoma (HCC) treated with three-dimensional conformal radiation therapy (3D-CRT). In addition, survival of patients and potential prognostic factors of the survival was evaluated.

Materials and methods: Forty-seven patients with PVT or HVT in HCC, referred to our department for radiotherapy, were retrospectively reviewed. For 3D-CRT plans, a gross tumor volume (GTV) was defined as a hypodense filling defect area in the portal vein (PV) or hepatic vein (HV). Survival of patients, and response to radiation therapy (RT) were analyzed. Potential prognostic factors for survival and response to RT were evaluated.

Results: The median survival time of 47 patients was 8 months, with 1-year survival rate of 15% and response rate of 40%. Changes in Child-Pugh score, response to RT, Eastern cooperative oncology group performance status (ECOG PS), hepatitis C antibody (HCVAb) positivity, and additional post RT treatment were statistically significant prognostic factors for survival in univariate analysis (p = 0.000, p = 0.018, p = 0.000, p = 0.013, and p = 0.047, respectively). Of these factors, changes in Child-Pugh score, and response to RT were significant for patients' prognosis in multivariate analysis (p = 0.001 and p = 0.035, respectively).

Conclusion: RT could constitute a reasonable treatment option for patients with PVT or HVT in HCC with acceptable toxicity. Changes in Child-Pugh score, and response to RT were statistically significant factors of survival of patients.

Keywords: Hepatic vein; Hepatocellular carcinoma; Portal vein; Radiotherapy.

Fig. 1.

The case of tumor response evaluation in a 47-year old man. The patient was diagnosed with hepatocellular carcinoma and referred to our department for radiotherapy of thrombus in the left portal vein. (A) The initial radiation therapy planning-computed tomography, showing the thrombus in the left portal vein and no portal flow. (B) The follow-up abdominal computed tomography, taken 24 days after completion of radiotherapy. The thrombus is reduced in size, and the portal flow is renewed.

Fig. 2.

The overall survival curve for the 47 patients treated with three-dimensional conformal radiation therapy (3D-CRT) for portal vein or hepatic vein thrombosis in hepatocellular carcinoma.