Clinical Study

Potential Prognostic Benefits of Radiotherapy as an Initial Treatment for Patients with Unresectable Advanced Hepatocellular Carcinoma with Invasion to Intrahepatic Large Vessels
Takahide Nakazawa^a, Shigeru Adachi^a, Masashi Kitano^b, Yoshinori Isobe^c, Shigehiro Kokubu^d, Hisashi Hidaka^a, Koji Ono^a, Yusuke Okuwaki^a, Masaaki Watanabe^a, Akitaka Shibuya^a, Katsunori Saigenji<sup>a

a</sup>Gastroenterology Division of Internal Medicine and
^bDepartment of Radiology, Kitasato University East Hospital, Sagamihara,
^cDepartment of Radiology, National Hospital Organization Tokyo Medical Center and
^dDepartment of Gastroenterology, Juntendo University, Tokyo, Japan

Address of Corresponding Author

Oncology 2007;73:90-97 (DOI: 10.1159/000120996)

  Key Words

• Radiotherapy
• Hepatocellular carcinoma
• Intrahepatic large vessels
• Portal vein tumor thrombosis

  Abstract

Objectives: To examine the efficacy and prognostic benefits of radiotherapy (RT) in patients who have unresectable advanced hepatocellular carcinoma (HCC) with invasion to intrahepatic large vessels (IHLVs). Methods: Sixty-eight patients who had advanced HCC with invasion to IHLVs were studied. Thirty-two consecutive patients initially received 3-dimensional conformal RT for HCC invasion to IHLVs. Tumor response, prognostic factors, and survival were studied in the patients given RT. Prognostic factors and survival were assessed in the study group as a whole. Data were analyzed using the Kaplan-Meier method, univariate analysis, and a Cox model. Results: The rate of objective response to RT was 48%. Predictors of survival in the patients who received RT were a hepatic function of Child-Pugh class A (p = 0.0263) and a response to RT (p = 0.0121). In the study group as a whole, independent predictors of survival in a Cox model were multinodular HCC (p = 0.007), inferior vena caval invasion (p = 0.001), a serum -fetoprotein level of >1,000 ng/ml (p = 0.032), and the performance of RT (p < 0.001). Notably, the median survival of the nonresponders to RT (n = 15) was significantly longer than that of the patients who received no treatment for HCC (n = 21; 7.0 vs. 3.4 months, p = 0.0014). Conclusion: RT is considered an effective initial treatment for HCC invasion to IHLVs, and may offer survival benefits, even in nonresponders, because of the induction of stable disease.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Takahide Nakazawa, MD, PhD
Gastroenterology Division of Internal Medicine
Kitasato University East Hospital, 2-1-1 Asamizodai
Sagamihara, Kanagawa 228-8520 (Japan)
Tel. +81 42 748 9111, Fax +81 42 740 1881, E-Mail tnakazaw@kitasato-u.ac.jp

  Article Information

Received: April 21, 2007
Accepted after revision: September 12, 2007
Published online: March 13, 2008
Number of Print Pages : 8
Number of Figures : 3, Number of Tables : 3, Number of References : 38