A clinical study on stereotactic body radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis

Purposes: Hepatocellular carcinoma with portal vein tumor thrombosis (HCC-PVTT) has a poor prognosis, while the optimal treatment remains controversial. The objective of this retrospective study was to evaluate the efficacy and safety of ray SBRT in treatment of patients with HCC-PVTT. Methods: The study was designed to examine the effects of ray SBRT on toxicity and survival in patients with HCC-PVTT. To this end, data from patients with HCC-PVTT who received ray SBRT during May 2008 to December 2011 was collected and analyzed. Response and (acute and late) toxicity were evaluated using the established international criteria. Log-rank test and Cox regression model were used to identify predictive factors and multivariate for survival, respectively. Results: The median follow up was 11 months. Fifty four consecutive patients with HCC-PVTT received daily fraction of 2.6 6Gy and six fractions per week for the total dose of 32.4 54Gy in 6 13 days. Six complete response (CR; 11.1%) and twenty five partial response (PR; 46.3%) were observed (overall response rate 57.4%). Twenty three patients displayed a stable disease (SD; 42.6%), while no patient experienced progressive disease (PD; 0%). The treatment was well tolerated with no radiation-related complication and no  Grade 3 toxicity. Oneand twoyear overall survival rate were 33.4% and 13.6% respectively, and median overall survival was 10.7 months. The prognostic factors for survival included ECOG performance status (P0.04), Child-Pugh score (P0.05), PVTT size (P0.02) and location (P0.05). Conclusions: Individual  ray SBRT appears to be feasible for treatment of patients with HCC-PVTT in whom other current therapies are contraindicated. PVTT size and ECOG performance status may represent the strongest predictive factors for survival.