Stereotactic body radiotherapy combined with transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombosis

The purpose of this study was to evaluate the clinical efficacy, toxicity and adverse effects of stereotactic body radiotherapy (SBRT) combined with transarterial chemoembolization (TACE) in patients with advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). A total of 101 patients diagnosed with primary HCC with PVTT were enrolled in this study and were randomly divided into three groups as follows: group A, 34 patients treated with gamma-SBRT followed by TACE; group B, 37 patients treated with TACE followed by gamma-SBRT; and group C, 30 patients treated with gamma-SBRT alone. The effective response rate for the entire patient sample was 87.1% (88/101) following a 3-month treatment. The differences in the response rate, survival rate, a-fetoprotein level restoration rate and rate of improvement of abdominal distention and discomfort between groups A and B were not statistically significant (P>0.05). However, the rates of groups A and B were higher compared to those of group C (P<0.05). The exacerbation rate of liver function in group A was lower compared to that in group B (P<0.05), although it exhibited no statistically significant difference from that in group C (P>0.05). No severe radiation-related complications were reported during the follow-up period. The combination of gamma-SBRT and TACE was shown to be a relatively effective local treatment for primary HCC patients with PVTT. Compared to gamma-SBRT followed by TACE and gamma-SBRT alone, TACE followed by gamma-SBRT may exert a negative effect on liver function. These results suggested that the combination of TACE and gamma-SBRT may be considered a relatively effective, safe and feasible treatment method for primary HCC patients with PVTT, although TACE followed by gamma-SBRT may negatively affect liver function.