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Clinical Results of Radiotherapy That Targeted for Tumor Thrombi from Hepatocellular Carcinoma: A Multicenter Retrospective Study

Received: 16 September 2020     Accepted: 27 September 2020     Published: 7 October 2020
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Abstract

Background: The aim of this multicenter study was to evaluate the outcome of radiotherapy (RT) that targeted for tumor thrombi (TT) from hepatocellular carcinoma (HCC), including the portal vein, hepatic vein, inferior vena cava, and bile duct TT. Methods: Patients who received RT for the treatment of TT between 2005 and 2020 were retrospectively reviewed. We compared patient characteristics, overall survival (OS), the combined chemotherapy regimen, and objective response rates (ORRs) between the treatment modalities and analyzed cumulative incidence formula (CIF) for the deterioration in the Child-Pugh class and the progression of intrahepatic tumors. Results: We evaluated 64 patients, 39 of whom received combined chemotherapy with RT. Multivariate analysis showed that the Child-Pugh class, primary tumor size and the response of TT were significant prognostic factors for OS and the total equivalent dose in 2 Gy fractions (EQD2) of more than 48.75 Gy significantly contributed to ORRs (p=0.04). In the multivariate analysis of CIF, only acute liver damage was the significant factor for the deterioration in the Child-Pugh class (p=0.01) and the length of TT was significant for the progression of intrahepatic tumors (p=0.03). Conclusion: High doses should be delivered to TT, but long tumor thrombi are difficult to control. Tumor thrombus length is more important in predicting intrahepatic progression than the location of the tumor thrombus.

Published in International Journal of Clinical Oncology and Cancer Research (Volume 5, Issue 3)
DOI 10.11648/j.ijcocr.20200503.13
Page(s) 65-77
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Combined Chemotherapy, Radiation Therapy, Hepatocellular Carcinoma, Macroscopic Vascular Invasion, Tumor Thrombosis

References
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    Takuya Nagano, Akihiko Hoshi, Masayuki Kurosaki, Kazuma Sasamura, Kaoru Tsuchiya, et al. (2020). Clinical Results of Radiotherapy That Targeted for Tumor Thrombi from Hepatocellular Carcinoma: A Multicenter Retrospective Study. International Journal of Clinical Oncology and Cancer Research, 5(3), 65-77. https://doi.org/10.11648/j.ijcocr.20200503.13

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    ACS Style

    Takuya Nagano; Akihiko Hoshi; Masayuki Kurosaki; Kazuma Sasamura; Kaoru Tsuchiya, et al. Clinical Results of Radiotherapy That Targeted for Tumor Thrombi from Hepatocellular Carcinoma: A Multicenter Retrospective Study. Int. J. Clin. Oncol. Cancer Res. 2020, 5(3), 65-77. doi: 10.11648/j.ijcocr.20200503.13

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    AMA Style

    Takuya Nagano, Akihiko Hoshi, Masayuki Kurosaki, Kazuma Sasamura, Kaoru Tsuchiya, et al. Clinical Results of Radiotherapy That Targeted for Tumor Thrombi from Hepatocellular Carcinoma: A Multicenter Retrospective Study. Int J Clin Oncol Cancer Res. 2020;5(3):65-77. doi: 10.11648/j.ijcocr.20200503.13

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  • @article{10.11648/j.ijcocr.20200503.13,
      author = {Takuya Nagano and Akihiko Hoshi and Masayuki Kurosaki and Kazuma Sasamura and Kaoru Tsuchiya and Kazuma Toda and Hirofumi Kuwabara and Meika Namba and Daigoro Matsubara and Sayako Oota and Yasuo Yoshioka and Ryoichi Yoshimura and Namiki Izumi},
      title = {Clinical Results of Radiotherapy That Targeted for Tumor Thrombi from Hepatocellular Carcinoma: A Multicenter Retrospective Study},
      journal = {International Journal of Clinical Oncology and Cancer Research},
      volume = {5},
      number = {3},
      pages = {65-77},
      doi = {10.11648/j.ijcocr.20200503.13},
      url = {https://doi.org/10.11648/j.ijcocr.20200503.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcocr.20200503.13},
      abstract = {Background: The aim of this multicenter study was to evaluate the outcome of radiotherapy (RT) that targeted for tumor thrombi (TT) from hepatocellular carcinoma (HCC), including the portal vein, hepatic vein, inferior vena cava, and bile duct TT. Methods: Patients who received RT for the treatment of TT between 2005 and 2020 were retrospectively reviewed. We compared patient characteristics, overall survival (OS), the combined chemotherapy regimen, and objective response rates (ORRs) between the treatment modalities and analyzed cumulative incidence formula (CIF) for the deterioration in the Child-Pugh class and the progression of intrahepatic tumors. Results: We evaluated 64 patients, 39 of whom received combined chemotherapy with RT. Multivariate analysis showed that the Child-Pugh class, primary tumor size and the response of TT were significant prognostic factors for OS and the total equivalent dose in 2 Gy fractions (EQD2) of more than 48.75 Gy significantly contributed to ORRs (p=0.04). In the multivariate analysis of CIF, only acute liver damage was the significant factor for the deterioration in the Child-Pugh class (p=0.01) and the length of TT was significant for the progression of intrahepatic tumors (p=0.03). Conclusion: High doses should be delivered to TT, but long tumor thrombi are difficult to control. Tumor thrombus length is more important in predicting intrahepatic progression than the location of the tumor thrombus.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Clinical Results of Radiotherapy That Targeted for Tumor Thrombi from Hepatocellular Carcinoma: A Multicenter Retrospective Study
    AU  - Takuya Nagano
    AU  - Akihiko Hoshi
    AU  - Masayuki Kurosaki
    AU  - Kazuma Sasamura
    AU  - Kaoru Tsuchiya
    AU  - Kazuma Toda
    AU  - Hirofumi Kuwabara
    AU  - Meika Namba
    AU  - Daigoro Matsubara
    AU  - Sayako Oota
    AU  - Yasuo Yoshioka
    AU  - Ryoichi Yoshimura
    AU  - Namiki Izumi
    Y1  - 2020/10/07
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ijcocr.20200503.13
    DO  - 10.11648/j.ijcocr.20200503.13
    T2  - International Journal of Clinical Oncology and Cancer Research
    JF  - International Journal of Clinical Oncology and Cancer Research
    JO  - International Journal of Clinical Oncology and Cancer Research
    SP  - 65
    EP  - 77
    PB  - Science Publishing Group
    SN  - 2578-9511
    UR  - https://doi.org/10.11648/j.ijcocr.20200503.13
    AB  - Background: The aim of this multicenter study was to evaluate the outcome of radiotherapy (RT) that targeted for tumor thrombi (TT) from hepatocellular carcinoma (HCC), including the portal vein, hepatic vein, inferior vena cava, and bile duct TT. Methods: Patients who received RT for the treatment of TT between 2005 and 2020 were retrospectively reviewed. We compared patient characteristics, overall survival (OS), the combined chemotherapy regimen, and objective response rates (ORRs) between the treatment modalities and analyzed cumulative incidence formula (CIF) for the deterioration in the Child-Pugh class and the progression of intrahepatic tumors. Results: We evaluated 64 patients, 39 of whom received combined chemotherapy with RT. Multivariate analysis showed that the Child-Pugh class, primary tumor size and the response of TT were significant prognostic factors for OS and the total equivalent dose in 2 Gy fractions (EQD2) of more than 48.75 Gy significantly contributed to ORRs (p=0.04). In the multivariate analysis of CIF, only acute liver damage was the significant factor for the deterioration in the Child-Pugh class (p=0.01) and the length of TT was significant for the progression of intrahepatic tumors (p=0.03). Conclusion: High doses should be delivered to TT, but long tumor thrombi are difficult to control. Tumor thrombus length is more important in predicting intrahepatic progression than the location of the tumor thrombus.
    VL  - 5
    IS  - 3
    ER  - 

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Author Information
  • Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan

  • Department of Radiology, Musashino Red Cross Hospital, Musashino-shi, Tokyo, Japan

  • Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino-shi, Tokyo, Japan

  • Department of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan

  • Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino-shi, Tokyo, Japan

  • Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan

  • Department of Radiology, Musashino Red Cross Hospital, Musashino-shi, Tokyo, Japan

  • Department of Radiology, Musashino Red Cross Hospital, Musashino-shi, Tokyo, Japan

  • Department of Radiology, Asahi General Hospital, Asahi-shi, Chiba, Japan

  • Department of Radiology, Asahi General Hospital, Asahi-shi, Chiba, Japan

  • Department of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan

  • Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan

  • Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino-shi, Tokyo, Japan

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