Therapeutic effect and prognostic analysis of intensity-modulated radiotherapy for primary hepatocellular carcinoma with portal vein and / or inferior vena cava tumor thrombus

Objective To determine the efficacy and prognostic factors of intensity- modulated radiotherapy( IMRT) for primary hepatocellular carcinoma( HCC) with portal vein and / or inferior vena cava tumor thrombus. Methods Twenty- three HCC patients with portal vein and / or inferior vena cava tumor thrombus received IMRT with an 8 MV linear accelerator at the Cancer Center of General Hospital of Armed Police Forces,Anhui Medical University,from April 2008 to August 2011. A single dose of 3 to 6 Gy was delivered at five fractions per week,with a total dose of 56 to 96 Gy and a median dose of 60 Gy. Survival time was recorded,and adverse reactions were evaluated. Survival rate calculation and survival analysis were performed using the Kaplan- Meier method. Comparison of categorical between two groups was made by chi- square test. Results One patient did not complete radiotherapy due to upper gastrointestinal bleeding. Of 22 patients who completed IMRT,4 achieved complete remission and 10 achieved partial remission,with an overall response rate of 63. 7%. Our analysis showed that the type of tumor thrombus and tumor size were associated with tumor response rate and were significant prognostic factors( P< 0. 05). The median survival time was 13. 4 months. The 1-,2-,and 3- year survival rates were 59%,27%,and 18%,respectively. The 22 patients who completed radiotherapy did not experience acute radiation injury or late adverse outcomes such as radiation- induced liver disease. Conclusion This study suggests IMRT is a safe and effective treatment option for HCC patients with portal vein and / or inferior vena cava tumor thrombus.