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Radiotherapy for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels: Efficacy and outcomes
Author(s) -
Tanaka Yoshiaki,
Nakazawa Takahide,
Komori Shouko,
Hidaka Hisashi,
Okuwaki Yusuke,
Takada Juichi,
Watanabe Masaaki,
Shibuya Akitaka,
Minamino Tsutomu,
Yamamoto Hajime,
Kokubu Shigehiro,
Hayakawa Kazushige,
Koizumi Wasaburo
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12333
Subject(s) - medicine , hepatocellular carcinoma , hazard ratio , confidence interval , gastroenterology , proportional hazards model , portal vein thrombosis , adverse effect , carcinoma , radiation therapy , liver function , thrombosis , oncology , surgery
Abstract Background and Aim To examine the efficacy and outcomes of radiotherapy ( RT ) in patients who have hepatocellular carcinoma with invasion to intrahepatic large vessels ( IHLV s). Methods Sixty‐seven patients who had advanced hepatocellular carcinoma with invasion to IHLVs received three‐dimensional conformal RT. IHLV invasion was associated with portal venous tumor thrombosis in 40 patients, tumor thrombosis involving the hepatic vein in 17, and both findings in 10. A daily radiation dose of 1.8–2 Gy was administered using 6 or 10 MV X ‐rays to deliver a total dose of 30–56 Gy. Results The overall objective response rate (complete response plus partial response) was 45% ( n = 30). The median survival time was 13.7 months in the responder group and 5.9 months in the nonresponder group. An objective response was observed in 28 (56%) of 50 patients with Child‐Pugh ( C ‐ P ) class A and in 2 (12%) of 17 patients with C ‐ P class B . Hepatic function of C ‐ P class A was an independent factor for both RT responder and overall survival on Cox regression analysis (hazard ratio = 9.5, 95% confidence interval = 1.97–46.2, P = 0.005; and hazard ratio = 0.39, 95% confidence interval = 0.2–0.77, P = 0.007, respectively). Conclusion RT is an effective treatment option without serious adverse events. RT should be considered for the patients with better hepatic function who have invasion to IHLV s.