Clinical results of radiotherapy for hepatocellular carcinoma with tumor thrombosis.

Abstract Background: The aim of this study was to evaluate the clinical outcome of radiotherapy (RT) for hepatocellular carcinoma (HCC) with the portal vein (PV), hepatic vein (HV), inferior vena cava (IVC), and bile duct (BD) tumor thrombosis (TT). Methods: Patients who received RT for the treatment of a primary tumor and tumor thrombosis at Musahino Red Cross Hospital between 2011 and 2019 were retrospectively reviewed. We compared patient characteristics, radiation dose, overall survival (OS), the combined chemotherapy regimen, and objective response rates (ORRs) between the treatment modalities. Results: We evaluated 43 patients who were treated with RT, 27 of whom received combined chemotherapy with RT. The total equivalent dose in 2 Gy fractions ranged from 42.25 to 72 Gy (median 48.75 Gy). The median follow-up period after RT was 13 months (range of 2–90 months). Multivariate analysis showed that the length of tumor thrombosis was a unique significant prognostic factor for OS (p = 0.01) and the prescribed equivalent dose of more than 48.75 Gy significantly contributed to ORRs (p = 0.02). When compared, the one-year OS rates of responders (n = 25) and non-responders (n = 18) were 75% and 35%, respectively (p = 0.009). The odds ratio of ORRs between the two total dose groups (42.35 Gy versus more than 48.75 Gy) was 9.8 (95% CI [2.1, 58.9], p = 0.001). Combined chemotherapy with RT was a prognostic factor for OS (p = 0.03), but it was not correlated with response rate (p = 0.53). Conclusion: Local control of tumor thrombosis was found to be a significant prognostic factor for OS in patients with HCC and its tumor thrombosis. Although various drug and treatment options for tumor thrombosis exist, RT provides a better OS.

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Myopenia as a significant prognostic factor in BCLC-B intermediate-stage hepatocellular carcinoma treated with sorafenib.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15639 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15639-e15639

Author(s):

Mao Okada ◽

Hiroyuki Nakanishi ◽

Masayuki Kurosaki ◽

Sakura Kirino ◽

Leona Osawa ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Skeletal Muscle ◽

Prognostic Factor ◽

Kinase Inhibitors ◽

Treatment Options ◽

Intermediate Stage ◽

Significant Prognostic Factor ◽

Poor Prognostic Factor ◽

Skeletal Muscle Index ◽

The Impact

e15639 Background: Tyrosine kinase inhibitors (TKI) are important treatment options for unresectable hepatocellular carcinoma (HCC). The survival benefit of sorafernib was demonstrated not only in advanced stage but also for BCLC-B intermediate stage who are refractory to transcatheter arterial chemoembolization by OPTIMIS study. Skeletal muscle mass depletion (Myopenia) is a poor prognostic factor in HCC treated by resection or loco-reginal ablation, but its effect on survival in TKI treated patients, especially in those within BCLC-B stage remains unclear. The aim of the present study is to elucidate the impact of myopenia on survival among HCC treated with sorafenib, especially in BCLC-B stage. Methods: In 213 patients who started treatment with sorafenib between 2009 and 2016, myopenia at baseline was determined by using skeletal muscle index calculated from CT images of the third lumber vertebra level. The impact of myopenia on survival was analyzed in whole patients, after stratification by BCLC stage, and after matching for backgrounds within BCLC-B patients. Results: The median survival in whole, BCLC-C, and –B was 13.7, 8.7 and 15.2 months, respectively. Myopenia was not a significant prognostic factor in whole patients and in BCLC-C stage. However, among BCLC-B patients (n = 104), survival was significantly better in patients with no myopenia (p = 0.05). Among them, 85 patients who continued sorafenib for more than 8 weeks were extracted and those with or without myopenia were matched for backgrounds by propensity score. Backgrounds including etiology, Child-Pugh score, BMI, AFP and PIVKA-Ⅱwas not different between myopenia (n = 30) and no myopenia group (n = 30) after matching. The overall survival at 6-, 12-, and 24-months was 96%, 74%, and 62% in no myopenia group which was significantly better compared to 89%, 64%, and 28% in myopenia group (p = 0.019). The hazard ratio was 2.12 (95% CI 1.11-4.03). Conclusions: Absence of myopenia predicts favorable outcome in sorafenib treated HCC patients within BCLC-B intermediate stage.

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Sorafenib for the Treatment of Unresectable Hepatocellular Carcinoma: Preliminary Toxicity and Activity Data in Dogs

Cancers ◽

10.3390/cancers12051272 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1272 ◽

Cited By ~ 1

Author(s):

Laura Marconato ◽

Silvia Sabattini ◽

Giorgia Marisi ◽

Federica Rossi ◽

Vito Ferdinando Leone ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Safety Profile ◽

Median Overall Survival ◽

Response Rate ◽

Treatment Options ◽

Objective Response ◽

Metronomic Chemotherapy ◽

Time To Progression ◽

Activity Data

Unresectable nodular and diffuse hepatocellular carcinoma (HCC) have a poor prognosis with limited treatment options. Systemic traditional chemotherapy has been only rarely reported, with unsatisfactory results. The aim of this prospective, non-randomized, non-blinded, single center clinical trial was to investigate safety profile, objective response rate, time to progression and overall survival of sorafenib in comparison with metronomic chemotherapy (MC) consisting of thalidomide, piroxicam and cyclophosphamide in dogs with advanced, unresectable HCC. Between December 2011 and June 2017, 13 dogs were enrolled: seven received sorafenib, and six were treated with MC. Median time to progression was 363 days (95% CI, 191–535) in dogs treated with sorafenib versus 27 days (95% CI, 0–68) in dogs treated with MC (p = 0.044). Median overall survival was 361 days (95% CI, 0–909) in dogs receiving sorafenib, while 32 days (95% CI, 0–235) in those receiving MC (p = 0.079). Sorafenib seems to be a good candidate for the treatment of dogs with advanced HCC, due to a benefit in disease control and an acceptable safety profile, offering a good basis on which new randomized prospective clinical trials should be undertaken to compare the efficacy and drawback of sorafenib versus MC or traditional chemotherapy.

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Medical Treatment of Hepatocellular Carcinoma: Any Progress?

Tumori Journal ◽

10.1177/030089169408000501 ◽

1994 ◽

Vol 80 (5) ◽

pp. 315-326 ◽

Cited By ~ 12

Author(s):

Marco Colleoni ◽

Fernando Gaion ◽

Guido Liessi ◽

Giorgio Mastropasqua ◽

Patrizia Nelli ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Treatment Options ◽

Arterial Embolization ◽

Percutaneous Ethanol Injection ◽

High Response Rate ◽

New Drugs ◽

Treatment Modalities ◽

Ethanol Injection ◽

Hormonal Manipulation ◽

Number Of Patients

Background Hepatocellular carcinoma (HCC) remains one of the most common neoplasms worldwide. Curative treatment options include liver transplantation or resection. Unfortunately, most patients still have unresectable or untransplantable HCC due to disease extension or comorbid factors and are therefore candidate only for palliative treatments. Methods In this review we have analyzed the different medical approaches employed in the treatment of HCC in an attempt to better define their roles. Results Palliative medical treatments including systemic chemotherapy, immunotherapy or hormonal manipulation rarely influence survival of the patients. Although a high response rate is often reported with new local therapies such as transcatheter arterial embolization, intraarterial chemotherapy or percutaneous ethanol injection, the real impact of these treatment modalities on patient survival remains to be determined. Conclusion One way to improve the diagnosis of HCC patients would be an appropriate approach to evaluate new drugs or treatment modalities. To answer all the open questions, further trials, possibly randomized, should be conducted on a substantial number of patients with homogeneous prognostic factors.

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Stereotactic-body radiotherapy for portal vein tumor thrombosis in hepatocellular carcinoma patients.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.442 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 442-442

Author(s):

Bae Kwon Jeong ◽

Hoon Sik Choi ◽

Ki Mun Kang ◽

Hojin Jeong ◽

Yun Hee Lee ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Portal Vein ◽

Stereotactic Body Radiotherapy ◽

Treatment Options ◽

Optimal Dose ◽

Portal Vein Tumor Thrombosis ◽

Hepatic Toxicity ◽

Effective Treatment Option ◽

Tumor Thrombosis ◽

Grade 3

442 Background: Portal vein tumor thrombosis (PVTT) is commonly accompanied by hepatocellular carcinoma (HCC) patients, and in these cases the treatment options became limited and treatment outcome was poor. Stereotactic body radiotherapy (SBRT) is one of the possible treatment options, which can deliver higher doses with highly conformal target have conducted for treatment of PVTT. However, only few studies about the SBRT have reported, even treatment schedules were not consistent. In this study, we report our institutional experience of treating PVTT in HCC patients using SBRT. Methods: 24 HCC patients with PVTT were treated with SBRT at our institution. All patients had unresectable HCC with PVTT, baseline liver function of Child-Pugh class A or B. SBRT was performed by Cyberknife based on 4D-simulation and 4D-planning. The prescription dose was 45 Gy in 3 fractions in 17 (70.8%) patients, and was modified to 39 to 42 Gy in 3 to 4 fractions in 7 (29.2%) patients whose target was large or adjacent to the bowel. After SBRT, transarterial chemoembolization (TACE) was performed in 16 (66.7%) patients within 3 months. Results: There were 2 (8.3%) patients of PVTT showed complete response, and 11 (45.8%) patients showed partial response. Stable disease was found in 7 (29.2%) patients, and progression in 4 (16.7%) patients. The response rate was lower in patients with tumor thrombus at main portal vein than those at branch of portal vein (main, 30% vs. branch, 71.4%, p = 0.052). The 1- and 2-year overall survival (OS) was 67.5%, 48.2%, respectively, with median survival of 20.8 months. The combination SBRT followed by TACE, and presence of grade 3 hepatic toxicities impacted on survival. The 1-year OS was 71.4% in patients whom TACE was combined after SBRT, which was higher than that of 14.6% who were treated with SBRT alone (p < 0.001). The 1-year OS was 81.1% in patients who did not occur grade 3 hepatic toxicity, while 0% in patients who had grade 3 hepatic toxicity (p = 0.002). Conclusions: SBRT is a relatively effective treatment option for HCC patients of PVTT. Especially combined with TACE. Finding an optimal dose schedule which can reduce hepatic toxicity, while keeping the response seems important to increase the survival.

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Effectiveness of Stereotactic Body Radiotherapy for Hepatocellular Carcinoma with Portal Vein and/or Inferior Vena Cava Tumor Thrombosis

PLoS ONE ◽

10.1371/journal.pone.0063864 ◽

2013 ◽

Vol 8 (5) ◽

pp. e63864 ◽

Cited By ~ 70

Author(s):

Mian Xi ◽

Li Zhang ◽

Lei Zhao ◽

Qiao-Qiao Li ◽

Su-Ping Guo ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Inferior Vena Cava ◽

Portal Vein ◽

Stereotactic Body Radiotherapy ◽

Inferior Vena ◽

Vena Cava ◽

Tumor Thrombosis

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The Progress in the Treatment of Hepatocellular Carcinoma With Portal Vein Tumor Thrombus

Frontiers in Oncology ◽

10.3389/fonc.2021.635731 ◽

2021 ◽

Vol 11 ◽

Author(s):

Fangzhou Luo ◽

Mengxia Li ◽

Jun Ding ◽

Shusen Zheng

Keyword(s):

Hepatocellular Carcinoma ◽

Portal Vein ◽

Tumor Thrombus ◽

Treatment Options ◽

Portal Vein Tumor Thrombus ◽

Treatment Modalities ◽

High Recurrence Rate ◽

Global Consensus ◽

Close Relationship ◽

Relationship Of

Hepatocellular carcinoma (HCC) is one of most prevalent cancer and is a serious healthcare issue worldwide. Portal vein tumor thrombus (PVTT) is a frequent complication and remains as the blockage in the treatment of HCC with high recurrence rate and poor prognosis. There is still no global consensus or standard guideline on the management of HCC with PVTT. In western countries, Sorafenib and Lenvatinib are recommended as the first-line treatment options for HCC patients with PVTT where this condition is now regarded as BCLC Stage C regardless of PVTT types. However, there is growing evidence that supports the close relationship of the extent of PVTT to the prognosis of HCC. Besides the targeted therapy, more aggressive treatment modalities have been proposed and practiced in the clinic which may improve the prognosis of HCC patients with PVTT and prolong the patients’ survival time, such as transarterial chemoembolization, radiotherapy, hepatic resection, liver transplantation, and various combination therapies. Herein, we aim to review and summarize the advances in the treatment of HCC with PVTT.

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