Conformal radiation therapy for portal vein tumor thrombosis of hepatocellular carcinoma

Background and purpose: The prognosis of patients with portal vein tumor thrombosis (PVTT) from hepatocellular carcinoma (HCC) is poor; without treatment, their survival is less than 3 months. We retrospectively evaluated the treatment outcomes of conformal radiation therapy (CRT) in patients with HCC-PVTT. Materials and methods: Thirty-eight HCC patients with PVTT in whom other treatment modalities were not indicated underwent CRT. The total dose was translated into a biologic effective dose (BED) of 23.4-59.5 Gy(10) (median 50.7 Gy(10)) as the alpha/beta ratio = 10. Predictive factors including the age, performance status, Child-Pugh classification, PVTT size, and BED were evaluated for tumor response and survival. Results: Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were observed in 6 (15.8%), 11 (28.9%), 17 (44.7%), and 4 (10.5%) patients, respectively. The response rate (CR + PR) was 44.7%. The PVTT size (<30 vs. >= 30 mm) and BED (<58 vs. >= 58 Gy(10)) were significant factors for tumor response. The median survival and 1-year survival rate were 9.6 months and 39.4%. The Child-Pugh classification (A vs. B) and BED were significant factors for survival. Conclusions: CRT is effective not only for tumor response but also for survival in HCC-PVTT patients in whom other treatment modalities are not indicated. (C0 2007 Elsevier Ireland Ltd. All rights reserved.