Abstract：Objective To assess the efficacy of combined treatment of TACE and EBRT in patients who were diagnosed as having hepatocellular carcinoma with portal vein tumor thrombosis and the relationships between patients’ characters and the therapeutic efficacy.Methods Fifty-three patients who were diagnosed as having hepatocellular carcinoma with portal vein thrombosis from January 1th, 2011 to December 31th,2013 were studied retrospectively. They were treated with local EBRT to PVTT and TACE to intrahepatic diseases. 3D-CRT,γ-knife and IMRT were included in the EBRT and PVTT and lymph nodes in portal hilar region were defined as the target volume. 60 Gy per 30 fractions,60 Gy per 20 fractions and 60 Gy per 12 fractions were used as the dose fractions. We collected the patients’ gender, age, ECOG score, hepatitis virus infection, Child-Pugh classification, AFP level, PVTT position, TACE and EBRT sequence, the radiation biological equivalent dose, curative effect of tumor thrombus, 1 year survival rate and treatment related adverse events.Results Twelve cases were evaluated as CR,22 as PR,20 as SD,5 as PD after these treatments respectively. The total response rate was 52.8% (28/53). Survival time ranged from 3.5 to 27.1 month for all patients, median survival time was 17.5 month. The one-year survival rates were different between groups with different ECOG, location of PVTT and treatment efficacy,and the results were significant. The toxicities were severe when TACE was performed first.Conclusions Combined treatment with local EBRT to PVTT and TACE to intrahepatic lesions is effective to those who are diagnosed as having HCC with PVTT. EBRT should be utilized firstly when the portal vein is obstructed totally.
李士成，黄九宁，黎 功. 肝动脉化疗栓塞联合体外放疗治疗肝细胞癌合并门静脉癌栓的安全性和有效性[J]. 武警医学, 2016, 27(7): 702-705.
LI Shicheng, HUANG Jiuning, and LI Gong. Clinical analysis of TACE combined with EBRT in treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombosis. Med. J. Chin. Peop. Armed Poli. Forc., 2016, 27(7): 702-705.
White D L,Kanwal F,El-Serag H B. Association between nonalcoholic fatty liver disease and risk for hepatocellular cancer,based on systematic review [J]. Clin Gastroenterol Hepatol,2012,10(12): 1342-1359.
[2]
Villa E, Moles A, Ferretti I, et al. Natural history of inoperable hepatocellular carcinoma: estrogen receptors status in the tumor is the strongest prognostic factor for survival [J]. Hepatology,2000,32(2): 233-238.
[3]
Livraghi T, Makisalo H, Line P D. Treatment options in hepatocellular carcinoma today [J]. Scand J Surg, 2011, 100(1): 22-29.
Liver Ganeer Study Group of Japan.Primary liver cancer in Japan:clinieopathologie features and results of surgical treatment[J].Ann Surg, 1990, 211(3): 277-287.
[7]
Cheng A L, Kang Y K, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial [J]. Lancet Oncol, 2009, 10(1): 25-34.
[8]
Llovet J M, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma [J]. N Engl J Med 2008, 359: 378-390.
[9]
Liu L, Zhang C, Zhao Y, et al. Transarterial chemoembolization for the treatment of advanced hepatocellular carcinoma with portal vein tumor thrombosis:prognostic factors in a single-center study of 188 patients [J]. Biomed Res Int, 2014, 2014: 194278.
[10]
Chung G E, Lee J H, Kim H Y, et al. Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival [J]. Radiology, 2011, 258(2): 627-634.
[11]
Chern M C, Chuang V P, Liang C T, et al. Transcatheter arterial chemoembolization for advanced hepatocellular carcinoma with portal vein invasion: safety, efficacy, and prognostic factors [J]. J Vasc Interv Radiol, 2014, 25(1): 32-40.
[12]
Wahl D R, Stenmark M H, Tao Y, et al. Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma[J]. J Clin Oncol, 2015, 33(1): 1-8.
[13]
Chen S C, Lian S L, Chang W Y. The effect of external radiotherapy in treatment of portal vein invasion in hepatocellular carcinoma [J]. Cancer Chemother Pharmacol, 1994, 33(Suppl): 124-127.
[14]
Yoon S M, Lim Y S, Won H J, et al. Radiotherapy plus transarterial chemoembolization for hepatocellular carcinoma invading the portal vein: long-term patient outcomes [J]. Int J Radiat Oncol Biol Phys, 2011, 82(5): 2004-2011.
[15]
Kim S W,Oh D,Park H C, et al. Transcatheter arterial chemoembolization and radiation therapy for treatment-nave patients with locally advanced hepatocellular carcinoma [J]. Radiat Oncol J, 2014, 32(1): 14-22.
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