Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area

Jung Ho Im, Sang Min Yoon, Hee Chul Park, Jong Hoon Kim, Jeong Il Yu, Tae Hyun Kim, Jun Won Kim, Taek Keun Nam, Kyubo Kim, Hong Seok Jang, Jin Hee Kim, Mi Sook Kim, Won Sup Yoon, Inkyung Jung, Jinsil Seong

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background & Aims: This nationwide, multicenter study investigated treatment outcomes as well as the optimal radiotherapeutic strategy in patients with hepatocellular carcinoma (HCC) and portal vein tumour thrombosis (PVTT). Methods: We retrospectively reviewed the records of 985 patients who received radiotherapy (RT) for PVTT. The median equivalent RT dose was 48.75 Gy. Combined treatment, defined as liver-directed treatments performed within a month of RT, was administered to 657 patients (66.7%). The PVTT and primary tumour were irradiated in 413 patients (41.9%), and PVTT only was targeted in 572 patients (58.1%). Results: The response rate of the PVTT was 51.8%, and RT responders had a significantly longer survival than non-responders (15.2 vs. 6.9 months). Equivalent RT dose and combined treatment predicted response of PVTT. The median overall survival (OS) was 10.2 months. Multivariate analysis revealed the equivalent RT dose ˃45 Gy and combined treatment as significant positive factors for OS. In the propensity score matching analysis, the combined treatment group had better OS than the no combined treatment group, whereas the OS of the PVTT + primary tumour group did not differ significantly from that of the PVTT only group. Conclusion: The equivalent RT dose ˃45 Gy, given in combination with other treatments, provided better PVTT control and OS. The optimal RT volume is suggested for either PVTT + primary or PVTT only. Taken together, multimodal treatment with equivalent RT dose higher than 45 Gy is recommended for patients with HCC and PVTT.

Original languageEnglish
Pages (from-to)90-100
Number of pages11
JournalLiver International
Volume37
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1

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Portal Vein
Hepatitis B
Hepatocellular Carcinoma
Thrombosis
Radiotherapy
Neoplasms
Survival
Therapeutics
Combined Modality Therapy
Propensity Score
Multicenter Studies
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

Im, Jung Ho ; Yoon, Sang Min ; Park, Hee Chul ; Kim, Jong Hoon ; Yu, Jeong Il ; Kim, Tae Hyun ; Kim, Jun Won ; Nam, Taek Keun ; Kim, Kyubo ; Jang, Hong Seok ; Kim, Jin Hee ; Kim, Mi Sook ; Yoon, Won Sup ; Jung, Inkyung ; Seong, Jinsil. / Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area. In: Liver International. 2017 ; Vol. 37, No. 1. pp. 90-100.
@article{6ab0eff10d5c4b298b57bb54b523b563,
title = "Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area",
abstract = "Background & Aims: This nationwide, multicenter study investigated treatment outcomes as well as the optimal radiotherapeutic strategy in patients with hepatocellular carcinoma (HCC) and portal vein tumour thrombosis (PVTT). Methods: We retrospectively reviewed the records of 985 patients who received radiotherapy (RT) for PVTT. The median equivalent RT dose was 48.75 Gy. Combined treatment, defined as liver-directed treatments performed within a month of RT, was administered to 657 patients (66.7{\%}). The PVTT and primary tumour were irradiated in 413 patients (41.9{\%}), and PVTT only was targeted in 572 patients (58.1{\%}). Results: The response rate of the PVTT was 51.8{\%}, and RT responders had a significantly longer survival than non-responders (15.2 vs. 6.9 months). Equivalent RT dose and combined treatment predicted response of PVTT. The median overall survival (OS) was 10.2 months. Multivariate analysis revealed the equivalent RT dose ˃45 Gy and combined treatment as significant positive factors for OS. In the propensity score matching analysis, the combined treatment group had better OS than the no combined treatment group, whereas the OS of the PVTT + primary tumour group did not differ significantly from that of the PVTT only group. Conclusion: The equivalent RT dose ˃45 Gy, given in combination with other treatments, provided better PVTT control and OS. The optimal RT volume is suggested for either PVTT + primary or PVTT only. Taken together, multimodal treatment with equivalent RT dose higher than 45 Gy is recommended for patients with HCC and PVTT.",
author = "Im, {Jung Ho} and Yoon, {Sang Min} and Park, {Hee Chul} and Kim, {Jong Hoon} and Yu, {Jeong Il} and Kim, {Tae Hyun} and Kim, {Jun Won} and Nam, {Taek Keun} and Kyubo Kim and Jang, {Hong Seok} and Kim, {Jin Hee} and Kim, {Mi Sook} and Yoon, {Won Sup} and Inkyung Jung and Jinsil Seong",
year = "2017",
month = "1",
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doi = "10.1111/liv.13191",
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Im, JH, Yoon, SM, Park, HC, Kim, JH, Yu, JI, Kim, TH, Kim, JW, Nam, TK, Kim, K, Jang, HS, Kim, JH, Kim, MS, Yoon, WS, Jung, I & Seong, J 2017, 'Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area', Liver International, vol. 37, no. 1, pp. 90-100. https://doi.org/10.1111/liv.13191

Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area. / Im, Jung Ho; Yoon, Sang Min; Park, Hee Chul; Kim, Jong Hoon; Yu, Jeong Il; Kim, Tae Hyun; Kim, Jun Won; Nam, Taek Keun; Kim, Kyubo; Jang, Hong Seok; Kim, Jin Hee; Kim, Mi Sook; Yoon, Won Sup; Jung, Inkyung; Seong, Jinsil.

In: Liver International, Vol. 37, No. 1, 01.01.2017, p. 90-100.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area

AU - Im, Jung Ho

AU - Yoon, Sang Min

AU - Park, Hee Chul

AU - Kim, Jong Hoon

AU - Yu, Jeong Il

AU - Kim, Tae Hyun

AU - Kim, Jun Won

AU - Nam, Taek Keun

AU - Kim, Kyubo

AU - Jang, Hong Seok

AU - Kim, Jin Hee

AU - Kim, Mi Sook

AU - Yoon, Won Sup

AU - Jung, Inkyung

AU - Seong, Jinsil

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background & Aims: This nationwide, multicenter study investigated treatment outcomes as well as the optimal radiotherapeutic strategy in patients with hepatocellular carcinoma (HCC) and portal vein tumour thrombosis (PVTT). Methods: We retrospectively reviewed the records of 985 patients who received radiotherapy (RT) for PVTT. The median equivalent RT dose was 48.75 Gy. Combined treatment, defined as liver-directed treatments performed within a month of RT, was administered to 657 patients (66.7%). The PVTT and primary tumour were irradiated in 413 patients (41.9%), and PVTT only was targeted in 572 patients (58.1%). Results: The response rate of the PVTT was 51.8%, and RT responders had a significantly longer survival than non-responders (15.2 vs. 6.9 months). Equivalent RT dose and combined treatment predicted response of PVTT. The median overall survival (OS) was 10.2 months. Multivariate analysis revealed the equivalent RT dose ˃45 Gy and combined treatment as significant positive factors for OS. In the propensity score matching analysis, the combined treatment group had better OS than the no combined treatment group, whereas the OS of the PVTT + primary tumour group did not differ significantly from that of the PVTT only group. Conclusion: The equivalent RT dose ˃45 Gy, given in combination with other treatments, provided better PVTT control and OS. The optimal RT volume is suggested for either PVTT + primary or PVTT only. Taken together, multimodal treatment with equivalent RT dose higher than 45 Gy is recommended for patients with HCC and PVTT.

AB - Background & Aims: This nationwide, multicenter study investigated treatment outcomes as well as the optimal radiotherapeutic strategy in patients with hepatocellular carcinoma (HCC) and portal vein tumour thrombosis (PVTT). Methods: We retrospectively reviewed the records of 985 patients who received radiotherapy (RT) for PVTT. The median equivalent RT dose was 48.75 Gy. Combined treatment, defined as liver-directed treatments performed within a month of RT, was administered to 657 patients (66.7%). The PVTT and primary tumour were irradiated in 413 patients (41.9%), and PVTT only was targeted in 572 patients (58.1%). Results: The response rate of the PVTT was 51.8%, and RT responders had a significantly longer survival than non-responders (15.2 vs. 6.9 months). Equivalent RT dose and combined treatment predicted response of PVTT. The median overall survival (OS) was 10.2 months. Multivariate analysis revealed the equivalent RT dose ˃45 Gy and combined treatment as significant positive factors for OS. In the propensity score matching analysis, the combined treatment group had better OS than the no combined treatment group, whereas the OS of the PVTT + primary tumour group did not differ significantly from that of the PVTT only group. Conclusion: The equivalent RT dose ˃45 Gy, given in combination with other treatments, provided better PVTT control and OS. The optimal RT volume is suggested for either PVTT + primary or PVTT only. Taken together, multimodal treatment with equivalent RT dose higher than 45 Gy is recommended for patients with HCC and PVTT.

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