A comparative study of treatment on portal vein tumor thrombosis in hepatocellular carcinoma with stereotactic radiotherapy versus three-dimensional conformal radiotherapy.

Background: Portal venous tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) is a poor prognostic factor, with median survival values ranging from 2 to 4 months, when untreated. Sorafenib has been used as a systemic therapy for advanced HCC patients with PVTT; however, its local effects are limited. We report the results of external beam radiotherapy for PVTT, including stereotactic radiotherapy.

Methods: Fifty consecutive HCC patients with PVTT who underwent external beam radiotherapy were investigated at our institution between January 2004 and December 2019.

Results: The median age of the patients was 71 years (range: 39-87). The patients were predominantly male (80%) who underwent three-dimensional conformal radiation therapy (82%). The Child-Pugh score was class A in 30(60%) patients and class B in 20(40%) patients. The median overall survival (OS) was 12.6 months (95% confidence interval [CI]: 7.2-18.2) and the 1-year overall survival rate for all patients was 52.3% (95% [CI]: 36.9 - 65.6). A favorable objective response rate was achieved in the stereotactic radiotherapy group (78%) compared to the three-dimensional conformal radiation therapy group (39%). Severe acute adverse events of grade 3 or higher were not observed.

Conclusions: The present study demonstrated the feasibility and efficacy of external beam radiotherapy for PVTT in patients with HCC.