Journal Article

Efficacy and safety of image-guided hypofractionated radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis: a retrospective, multicenter study

Choi, Jin Hwa, Yu, Su Jong, Lee, Jeong-Hoon, Kang, Hyun-Cheol, Kim, Yoon Jun, Chie, Eui Kyu, Lee, Sang Min, Yoon, Jung-Hwan, Kim, Kyung Su

2025

Overview

Background External beam radiation therapy (RT) has shown promising effects for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) in recent studies. However, there is still a lack of consensus on the optimal RT scheme for PVTT treatment. We evaluated the efficacy and safety of image-guided 10-fraction hypofractionated RT in these patients. Methods Between January 2016 and March 2022, a total of 95 HCC patients with PVTT received 10-fraction hypofractionated image-guided radiation therapy (IGRT) at two institutes, and 69 patients were analyzed. Follow-up imaging was performed at three-month intervals after the completion of RT. The extent of PVTT was described according to the Liver Cancer Study Group of Japan classification: Vp1 = segmental portal vein branch, Vp2 = right/left anterior/posterior portal vein, Vp3 = right/left portal vein, and Vp4 = main portal vein. Response evaluation was performed using Response Evaluation Criteria in Solid Tumors, version 1.1. Freedom from local progression (FFLP), progression-free survival (PFS), and overall survival (OS) were calculated from the start date of RT. Results The median prescribed dose of 50 Gy (range: 40-50 Gy; biologically effective dose [BED]: 56-75Gy 10 ) was delivered in 10 fractions. In this cohort, 4.3% of patients had Vp1, 20.3% had Vp2, 37.7% had Vp3, and 37.7% had Vp4. Median Planning target volume was 105.3 cc (interquartile range [IQR], 74.1–179.4 cc). Fifty-two (75.4%) patients received 50 Gy. With a median follow-up of 10.2 months (IQR, 6–21 months), the median OS was 20.3 months, and 1-year FFLP, PFS, and OS rates were 88.7%, 26.9%, and 62.2%, respectively. At 3 months follow-up, 13.0% had a complete response, 36.2% had a partial response, 46.4% had a stable disease and 4.4% had a progressive disease. In the multivariate analysis, alpha-fetoprotein level ≥ 600 IU/ml (hazard ratio [HR] 2.06, p  = 0.03), Child–Pugh Class B or C (HR 2.30, p  = 0.02), and stage IVA or IVB (4.05, p  = 0.02) were significantly related to OS. During the follow-up period, there were 2 (2.9%) cases of grade ≥ 3 toxicity: grade 3 liver enzyme elevation ( n  = 1), and acute cholangitis ( n  = 1). Conclusions Hypofractionated RT demonstrated promising local PVTT control and OS rates with acceptable toxicity. These data suggest that 10-fraction image-guided hypofractionated RT (BED: 56–75 Gy 10 ) is a feasible treatment option for PVTT in HCC patients.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Aged, 80 and over / Antimitotic agents / Antineoplastic agents / Biomedical and Life Sciences / Biomedicine / Cancer Research / Cancer therapies / Carcinoma, Hepatocellular - complications / Carcinoma, Hepatocellular - mortality / Carcinoma, Hepatocellular - pathology / Carcinoma, Hepatocellular - radiotherapy / Care and treatment / Cholangitis / Complications and side effects / Diagnosis / Dosage and administration / Female / Fractionation / Health Promotion and Disease Prevention / Hepatocellular carcinoma / Hepatoma / Humans / Hypofractionated radiation therapy / Image-guided radiation therapy / Liver cancer / Liver Neoplasms - complications / Liver Neoplasms - mortality / Liver Neoplasms - pathology / Liver Neoplasms - radiotherapy / Magnetic resonance imaging / Male / Medical imaging / Medical prognosis / Medicine/Public Health / Metastasis / Middle Aged / Multivariate analysis / Oncology / Patient outcomes / Patients / Portal vein / Portal Vein - pathology / Portal vein tumor thrombosis / Radiation Dose Hypofractionation / Radiation therapy / Radiotherapy / Radiotherapy, Image-Guided - adverse effects / Radiotherapy, Image-Guided - methods / Retrospective Studies / Small intestine / Solid tumors / Surgical Oncology / Survival / Thrombosis / Toxicity / Treatment Outcome / Tumors / Veins & arteries / Venous thrombosis / Venous Thrombosis - etiology / Venous Thrombosis - pathology / Venous Thrombosis - radiotherapy / α-Fetoprotein