Key result
Hypofractionated radiotherapy yielded a 96% objective response rate and a median overall survival of 10 months in recurrent hepatocellular carcinoma with tumor thrombus, with no significant survival difference between IVC and IVC+RA locations (p=0.205).
Why the study?
Recurrent hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus is considered terminal, and there is no worldwide consensus on its proper management.
Does hypofractionated radiotherapy improve survival and tumor response in patients with recurrent hepatocellular carcinoma and inferior vena cava/right atrium tumor thrombus?
Cohort (n=75)
Yes
Does hypofractionated radiotherapy improve survival and tumor response in patients with recurrent hepatocellular carcinoma and inferior vena cava/right atrium tumor thrombus?
Absolute Event Rate: 13.8% vs 11.6%
p-value: p=0.205
Hypofractionated radiotherapy provides a high objective response rate and a median overall survival of 10 months for patients with recurrent HCC and IVC/RA tumor thrombus, with manageable toxicity.
May support hypofractionated radiotherapy in recurrent HCC with IVC/RA thrombus; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Recurrent hepatocellular carcinoma (HCC) with a tumor thrombus (TT) extending into the inferior vena cava (IVC)/right atrium (RA) is generally regarded as a terminal-stage condition and there is no worldwide consensus on the proper management of this situation. In the present study, we report the efficacy of hypofractionated radiotherapy (HFRT) as a salvage treatment for recurrent HCC with IVC/RA TT. METHODS: We retrospectively reviewed 75 HCC patients with an IVC/RA TT who were referred for HFRT at three institutions between 2008 and 2016. 57 cases had a TT located in the IVC (IVC group), and 18 cases had a TT located in the IVC and RA (IVC + RA group). HFRT was designed to focus on the TT with or without the primary intrahepatic tumors. RESULTS: In all cases, the TT completely disappeared (CR) in 17 patients (22.7%), 55 patients (73.3%) had a partial response (PR), and 3 patients (4.0%) had a stable disease (SD). There were no cases of progressive disease (PD). The 1-, 2-, and 3-year overall survival rates of the 75 patients were 38.7% (29/75), 13.3% (10/75) and 5.3% (4/75), respectively. The overall median survival time was 10 months. The mean survival times for the IVC group and IVC+ RA group were 13.8 ± 1.1 and 11.6 ± 2.5 months, respectively. There was no significant difference in survival between the two groups (p = 0.205). Log-rank test revealed that factors predicting poor survival were Child-Pugh B liver function classification, AFP ≥ 400 μg/L, intrahepatic multiple tumors, distant metastases, only the TT as the target, a biological effective dose (BED) < 55 Gy and no chance of further radiotherapy. CONCLUSIONS: HFRT appears to be an effective and reasonable treatment option for recurrent HCC patients with IVC/RA TT. The location of the tumor thrombus, either in IVC or in IVC and RA, is not the factor that influences the efficacy of radiotherapy or survival.
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Lou et al. (2019) conducted a cohort in Recurrent hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus (n=75). Hypofractionated radiotherapy vs. IVC + RA tumor thrombus (vs IVC tumor thrombus) was evaluated on Mean overall survival (months) (p=0.205). Hypofractionated radiotherapy yielded a 96% objective response rate and a median overall survival of 10 months in recurrent hepatocellular carcinoma with tumor thrombus, with no significant survival difference between IVC and IVC+RA locations (p=0.205).
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