Liver Cancer
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2005; 11(46): 7237-7241
Published online Dec 14, 2005. doi: 10.3748/wjg.v11.i46.7237
Radiation therapy for portal venous invasion by hepatocellular carcinoma
Keiichi Nakagawa, Hideomi Yamashita, Kenshiro Shiraishi, Naoki Nakamura, Masao Tago, Hiroshi Igaki, Yoshio Hosoi, Shuichiro Shiina, Masao Omata, Masatoshi Makuuchi, Kuni Ohtomo
Keiichi Nakagawa, Hideomi Yamashita, Kenshiro Shiraishi, Naoki Nakamura, Masao Tago, Hiroshi Igaki, Yoshio Hosoi, Kuni Ohtomo, Department of Radiology, University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8865, Japan
Shuichiro Shiina, Masao Omata, Department of Gastroenterology, University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8865, Japan
Masatoshi Makuuchi, Department of Hepatobiliary Surgery, University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8865, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Keiichi Nakagawa, Department of Radiology, Faculty of Medicine, University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan. nakagawa-rad@umin.ac.jp
Telephone: +81-3-58008667 Fax: +81-3-58008935
Received: February 17, 2005
Revised: June 23, 2005
Accepted: July 1, 2005
Published online: December 14, 2005
Abstract

AIM: To clarify the efficacy and safety of three-dimensional conformal radiotherapy (3-D CRT) for this disease and to specify patient subgroups suitable for this treatment.

METHODS: Fifty-two patients with HCC received PVI-targeted radiation therapy from January 1995 through December 2003. Portal venous invasion (PVI) was found in the second or lower order branches of the portal vein in 6 patients, in the first branch in 24 patients and in the main trunk in 22 patients. Child classifications of liver function before radiation therapy were A, B, and C for 19, 24 and 2 patients, respectively. All patients received three-dimensional conformal radiotherapy with a total dose ranging from 39 to 60 Gy (57.0 Gy in average).

RESULTS: Overall survival rates at 1, 2, 3, 4, and 5 years were 45.1%, 25.3%, 15.2%, 10.1%, and 5.1%, respectively. Univariate analysis revealed that Child status, the number of tumor foci, tumor type, transcatheter arterial embolization (TAE) after radiation therapy were statistically significant prognostic factors. Multivariate analysis showed that the number of tumor foci and TAE after radiation therapy were statistically significant.

CONCLUSION: The results of this study strongly suggest the efficacy of 3-D CRT as treatment for PVI in HCC. 3-D CRT is recommended in combination with post-radiation TAE for PVI of HCC with 5 tumor foci or less in the liver and with Child A liver function.

Keywords: Hepatocellular carcinoma, Portal venous invasion, Radiation therapy