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. 2024 Feb 14;24(1):54.
doi: 10.1186/s12893-024-02334-1.

Efficacy of radiotherapy in combined treatment of hepatocellular carcinoma patients with portal vein tumor thrombus: a real-world study

Ying Xiao #  1 , Keren Li #  2 , Ying Zhao  3 , Shizhong Yang  2 , Jun Yan  2 , Canhong Xiang  2 , Jianping Zeng  2 , Qian Lu  2 , Chen Zhang  4 , Gong Li #  3 , Guangxin Li #  5 , Jiahong Dong #  2   6
Affiliations

Efficacy of radiotherapy in combined treatment of hepatocellular carcinoma patients with portal vein tumor thrombus: a real-world study

Ying Xiao et al. BMC Surg. .

Abstract

Background and aims: Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) has an extremely poor prognosis. A previous study proved that low-dose radiotherapy (RT) could prolong the prognosis of HCC patients with PVTT. This study aims to explore the sensitivity of PVTT to RT treatment.

Methods: Patients were selected based on imaging diagnosis of HCC accompanied by PVTT and received combined treatment of radiotherapy, antiangiogenic drugs and immune checkpoint inhibitors, followed by hepatectomy or liver transplantation from January 2019 to August 2022. The efficacy was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) guidelines and pathological assessment. The sensitivity of tumor cells to the treatment was compared between the primary tumor (PT)and PVTT by analyzing their residual tumor and pathologic complete remission (PCR) incidence.

Results: Data from 14 patients were collected in the study. After combined treatment, the size of PVTT decreased more significantly than that of the primary tumor in the imaging study (p < 0.05). The residual cancer was significantly more restrictive than that of primary tumor in paired patients based on pathological measurement (p = 0.008). The PCR incidence of the primary tumor (21.42%) was significantly lower (p = 0.008) than that of PVTT in the pathologic study (78.57%).

Conclusion: PVTT is more sensitive to radiotherapy treatment than the primary tumor in patients with HCC. This combination therapy might be an effective option as a downstaging therapy for patients with HCC with PVTT.

Keywords: Hepatocellular carcinoma; Portal vein tumor thrombosis; RACIB; Radiotherapy.

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Conflict of interest statement

All authors declare that they have no conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Representative sequential MRI images for one patient. (A) The images show the primary tumor and PVTT before RT treatment. (B) The images show the primary tumor and PVTT after RT treatment MRI: magnetic resonance imaging; PT: primary tumor; PVTT: portal vein tumor
Fig. 2
Fig. 2
Microscopic findings of primary lesions and PVTT with different therapeutic effect. (A)-(C) Tumor necrosis and residual tumor cells of the primary lesions in different patients. (D)-(F) Tumor necrosis and residual tumor cells of PVTT in different patients. *: Tumor necrosis. →: residual tumor cells PVTT: portal vein tumor
Fig. 3
Fig. 3
The comparison of residual cancer burden between PT and PVTT. *p < 0.05, **p < 0.01, ***p < 0.001 PT: primary tumor; PVTT: portal vein tumor
See this image and copyright information in PMC

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