Co-Radiotherapy with Tyrosine Kinase Inhibitors Might Benefit Survival in Hepatoma Patients with Portal Vein Tumor Thrombosis

Abstract

Background: Hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is associated with a poor prognosis, and current treatment options yield suboptimal results. This article aims to share our treatment outcomes for PVTT using tyrosine kinase inhibitors (TKIs), radiation therapy (RT), and their combination.

Methods: From 2010 to 2021, a total of 160 Child-Pugh class A HCC patients with PVTT, but without extrahepatic spread, were enrolled. Among them, 26, 10, 81, and 43 patients underwent no treatment, RT, TKIs, and combination therapy, respectively.

Results: Compared to the no treatment group (median survival: 2 months), the RT group (4.5 months, p=0.034), TKIs group (5.0 months, p=0.0017), and combination group (15.0 months, p<0.001) all demonstrated a survival benefit. The multivariate Cox model showed adjusted hazard ratios and 95% confidence intervals of 0.35 (0.16-0.78), 0.40 (0.25-0.63) and 0.26 (0.15-0.44) for RT, TKIs, combination groups, respectively. From clinical observation of patients who survived for two years, we found that 20% of RT patients achieved good local control, and the RT group had longer durations of TKI use.

Conclusions: In this series, 26.9% (43/160) of HCC patients with PVTT underwent combination treatment with TKIs and RT, achieving a median survival of 15.0 months. The contributions of RT were 20% disease control rate and may extend the duration of TKIs use. Therefore, all candidates without contraindications should be considered for combination treatment.

Keywords: Tyrosine kinase inhibitors (TKIs); hepatocellular carcinoma (HCC); overall survival(OS); portal vein tumor thrombus (PVTT); radiation therapy (RT).