The Dose of Palliative External-Beam Radiation Do Not Influence The Survival of Patients in Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HOU Jiazhou ¹ , ZENG Zhaochong ¹ , ZHANG Jianying ¹ , FAN Jia ² , ZHOU Jian ² , ZENG Mengsu. ³

1. Department of Radiation Oncology， Zhongshan Hospital Fudan University,Shanghai 200032, China;;
2. Liver Cancer Institute， Zhongshan Hospital Fudan University， Shanghai 200032， China;;
3. Department of Radiology， Zhongshan Hospital Fudan University， Shanghai 200032， China;

Corresponding author：

Keywords：

Hepatocellular carcinoma; Tumor thrombus; External-beam radiation therapy; Transcatheter arterialchemoembolization; Prognosis factor

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Objective 　To evaluate the effectiveness and prognosis of patients in advanced hepatocellular carcinoma (HCC) with portal vein (PV) tumor thrombus received external-beam radiation therapy (EBRT).
Methods 　The clinical data of 126 HCC patients with PV tumor thrombus who were referred for EBRT at our institution from January 2000 to November 2009 were analyzed retrospectively. EBRT was designed to focus on the tumor thrombus with or without primary intrahepatic tumors， to deliver a median total conventional dose of 50 Gy (range of 30-60 Gy). Predictors of survival were identified using univariate and multivariate analysis.
Results 　Unfavorable pretreatment predictors were associated by multivariate analysis with lower albumin and higher α-fetoprotein levels, poorer Child-Pugh liver function classification, poorer intrahepatic tumor control， lymph node metastases， and the two-dimensional EBRT technique. The dose of EBRT showed no significant in both univariate and multivariate survival analysis.
Conclusions 　In patients with HCC， EBRT is effectively prevents progression in cases of PV tumor thrombus， but palliative dose of EBRT is not related to survival.EBRT is not related to survival.

Citation： HOU Jiazhou,ZENG Zhaochong,ZHANG Jianying,FAN Jia,ZHOU Jian,ZENG Mengsu.. The Dose of Palliative External-Beam Radiation Do Not Influence The Survival of Patients in Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(3): 247-251. doi: Copy

1.	Pirisi M， Avellini C， Fabris C， et al. Portal vein thrombosis in hepatocellular carcinoma： age and sex distribution in an autopsy study [J]. J Cancer Res Clin Oncol， 1998， 124(7)：397-400.
2.	Park KW， Park JW， Choi JI， et al. Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area [J]. J Gastroenterol Hepatol， 2008，23(3)：467-473.
3.	Fong Y， Sun RL， Jarnagin W， et al. An analysis of 412 cases of hepatocellular carcinoma at a Western Center [J]. Ann Surg，1999， 229(6)：790-800.
4.	Cheung TK， Lai CL， Wong BC， et al. Clinical features， biochemical parameters， and virological profiles of patients with hepatocellular carcinoma in Hong Kong [J]. Aliment Pharmacol Ther， 2006， 24(4)：573-583.
5.	Takizawa D， Kakizaki S， Sohara N， et al. Hepatocellular carcinoma with portal vein tumor thrombosis： clinical characteristics，prognosis， and patient survival analysis [J]. Dig Dis Sci， 2007，52(11)：3290-3295.
6.	Jang JW， Bae SH， Choi JY， et al. A combination therapy with transarterial chemo-lipoidolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management [J]. Cancer Chemother Pharmacol， 2007， 59(1)：9-15.
7.	Okada S. How to manage hepatic vein tumour thrombus in hepatocellular carcinoma [J]. J Gastroenterol Hepatol， 2000， 15(4)：346-348.
8.	Le Treut YP， Hardwigsen J， Ananian P， et al. Resection of hepa中国普外基础与临床杂志2012 年3 月第19 卷第3 期 Chin J Bases Clin General Surg, Vol. 19, No. 3, Mar. 2012 ? 251 ?tocellular carcinoma with tumor thrombus in the major vasculature.A European case-control series [J]. J Gastrointest Surg，2006， 10(6)：855-862.
9.	Lee IJ， Chung JW， Kim HC， et al. Extrahepatic collateral artery supply to the tumor thrombi of hepatocellular carcinoma invading inferior vena cava： the prevalence and determinant factors [J]. J Vasc Interv Radiol， 2009， 20(1)：22-29.
10.	Ando E， Tanaka M， Yamashita F， et al. Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis： Analysis of 48 cases [J]. Cancer， 2002，95(3)：588-595.
11.	Hawkins MA， Dawson LA. Radiation therapy for hepatocellular carcinoma： from palliation to cure [J]. Cancer， 2006， 106(8)：1653-1663.
12.	Krishnan S， Dawson LA， Seong J， et al. Radiotherapy for hepatocellular carcinoma： an overview [J]. Ann Surg Oncol， 2008，15(4)：1015-1024.
13.	Zeng ZC， Fan J， Tang ZY， et al. A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus [J]. Int J Radiat Oncol Biol Phys， 2005， 61(2)：432-443.
14.	Igaki H， Nakagawa K， Shiraishi K， et al. Three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava invasion [J]. Jpn J Clin Oncol， 2008， 38(6)：438-444.
15.	Bruix J， Sherman M; Practice Guidelines Committee， et al. Management of hepatocellular carcinoma [J]. Hepatol， 2005， 42(5)：1208-1236.
16.	Tazawa J， Maeda M， Sakai Y， et al. Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement [J]. J Gastroenterol Hepatol， 2001， 16(6)：660-665.
17.	Ishikura S， Ogino T， Furuse J， et al. Radiotherapy after transcatheter arterial chemoembolization for patients with hepatocellular carcinoma and portal vein tumor thrombus [J]. Am J Clin Oncol， 2002， 25(2)：189-193.
18.	Yamada K， Izaki K， Sugimoto K， et al. Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma [J]. Int J Radiat Oncol Biol Phys， 2003， 57(1)：113-119.
19.	Koo JE， Kim JH， Lim YS，et al. Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus [J]. Int J Radiat Oncol Biol Phys， 2010， 78(1)：180-187.
20.	Valla DC， Condat B. Portal vein thrombosis in adults： pathophysiology，pathogenesis and management [J]. J Hepatol，2000， 32(5)：865-871.

1. Pirisi M， Avellini C， Fabris C， et al. Portal vein thrombosis in hepatocellular carcinoma： age and sex distribution in an autopsy study [J]. J Cancer Res Clin Oncol， 1998， 124(7)：397-400.
2. Park KW， Park JW， Choi JI， et al. Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area [J]. J Gastroenterol Hepatol， 2008，23(3)：467-473.
3. Fong Y， Sun RL， Jarnagin W， et al. An analysis of 412 cases of hepatocellular carcinoma at a Western Center [J]. Ann Surg，1999， 229(6)：790-800.
4. Cheung TK， Lai CL， Wong BC， et al. Clinical features， biochemical parameters， and virological profiles of patients with hepatocellular carcinoma in Hong Kong [J]. Aliment Pharmacol Ther， 2006， 24(4)：573-583.
5. Takizawa D， Kakizaki S， Sohara N， et al. Hepatocellular carcinoma with portal vein tumor thrombosis： clinical characteristics，prognosis， and patient survival analysis [J]. Dig Dis Sci， 2007，52(11)：3290-3295.
6. Jang JW， Bae SH， Choi JY， et al. A combination therapy with transarterial chemo-lipoidolization and systemic chemo-infusion for large extensive hepatocellular carcinoma invading portal vein in comparison with conservative management [J]. Cancer Chemother Pharmacol， 2007， 59(1)：9-15.
7. Okada S. How to manage hepatic vein tumour thrombus in hepatocellular carcinoma [J]. J Gastroenterol Hepatol， 2000， 15(4)：346-348.
8. Le Treut YP， Hardwigsen J， Ananian P， et al. Resection of hepa中国普外基础与临床杂志2012 年3 月第19 卷第3 期 Chin J Bases Clin General Surg, Vol. 19, No. 3, Mar. 2012 ? 251 ?tocellular carcinoma with tumor thrombus in the major vasculature.A European case-control series [J]. J Gastrointest Surg，2006， 10(6)：855-862.
9. Lee IJ， Chung JW， Kim HC， et al. Extrahepatic collateral artery supply to the tumor thrombi of hepatocellular carcinoma invading inferior vena cava： the prevalence and determinant factors [J]. J Vasc Interv Radiol， 2009， 20(1)：22-29.
10. Ando E， Tanaka M， Yamashita F， et al. Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis： Analysis of 48 cases [J]. Cancer， 2002，95(3)：588-595.
11. Hawkins MA， Dawson LA. Radiation therapy for hepatocellular carcinoma： from palliation to cure [J]. Cancer， 2006， 106(8)：1653-1663.
12. Krishnan S， Dawson LA， Seong J， et al. Radiotherapy for hepatocellular carcinoma： an overview [J]. Ann Surg Oncol， 2008，15(4)：1015-1024.
13. Zeng ZC， Fan J， Tang ZY， et al. A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus [J]. Int J Radiat Oncol Biol Phys， 2005， 61(2)：432-443.
14. Igaki H， Nakagawa K， Shiraishi K， et al. Three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava invasion [J]. Jpn J Clin Oncol， 2008， 38(6)：438-444.
15. Bruix J， Sherman M; Practice Guidelines Committee， et al. Management of hepatocellular carcinoma [J]. Hepatol， 2005， 42(5)：1208-1236.
16. Tazawa J， Maeda M， Sakai Y， et al. Radiation therapy in combination with transcatheter arterial chemoembolization for hepatocellular carcinoma with extensive portal vein involvement [J]. J Gastroenterol Hepatol， 2001， 16(6)：660-665.
17. Ishikura S， Ogino T， Furuse J， et al. Radiotherapy after transcatheter arterial chemoembolization for patients with hepatocellular carcinoma and portal vein tumor thrombus [J]. Am J Clin Oncol， 2002， 25(2)：189-193.
18. Yamada K， Izaki K， Sugimoto K， et al. Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma [J]. Int J Radiat Oncol Biol Phys， 2003， 57(1)：113-119.
19. Koo JE， Kim JH， Lim YS，et al. Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus [J]. Int J Radiat Oncol Biol Phys， 2010， 78(1)：180-187.
20. Valla DC， Condat B. Portal vein thrombosis in adults： pathophysiology，pathogenesis and management [J]. J Hepatol，2000， 32(5)：865-871.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Dose of Palliative External-Beam Radiation Do Not Influence The Survival of Patients in Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

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