We are reporting our results from a retrospective study of selective patients with advanced HCC and IVTT that were not eligible for surgery, radiofrequency ablation, embolization, or chemotherapy that were treated with three-dimensional conformal radiotherapy (3DCRT).
Between 2007 and 2012, in a retrospective way, 9 patients that had diagnosed with advanced HCC and IVTT received 3DCRT.
The inclusion criteria were as follows: HCC stage T2-T4 with IVTT, unresectable disease or medically unsuitable for resection, more than 800 cc of uninvolved liver, Eastern Cooperative Oncology Group Performance status 0-2 and Child-Pugh Stage A-B.
The gross tumor volume (GTV) included both primary tumor and IVTT as they were visualized on the planning CT or after fusion with magnetic resonance imaging.
The subject of this study was to assess the efficacy, feasibility, and toxicity of 3DCRT in patients with HCC and IVTT.
Patients with HCC, IVTT, and cirrhosis are not eligible to undergo resection or liver transplantation.
More specifically, when 3DCRT is used, it is safe to target only the tumor and the IVTT, plus the closely abutting partial volume of hepatic tumor.
In our study it has been proved that there is a good correlation between the total dose of 50-52 Gy and the objective response since it was demonstrated a treatment response rate of up to 60%, in patients with HCC, IVTT, and cirrhosis unfit for other modalities.
Well promising results have been published too, when hypofractionated schemes were delivered to HCCs and IVTT through stereotactic body radiotherapy, demonstrating that liver is radiosensitive, the control of IVTT is and independent prognostic factor and that treatment response leads to better overall survivals [30, 31].
More specifically, it was achieved a median recurrence free survival and a median overall survival of 21 months and 24 months, respectively, unlike the expected three-month life, when no treatment is delivered to this group of patients with HCC and IVTT.
Especially in patients with IVTT or PVTT, radiotherapy can be used as a treatment option in order to shrink the vascular thrombus.
Our study showed that 3DCRT is a feasible and safe modality to treat patients with HCC, IVTT and cirrhosis, with a scheme of 50-52 Gy in 2 Gy fractions.