Hypofractionated radiotherapy as a salvage treatment for recurrent hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus: a multi-center analysis

Abstract

BackgroundRecurrent 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.MethodsWe 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\u2009+\u2009RA group). HFRT was designed to focus on the TT with or without the primary intrahepatic tumors.ResultsIn 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\u2009months. The mean survival times for the IVC group and IVC+ RA group were 13.8\u2009±\u20091.1 and 11.6\u2009±\u20092.5\u2009months, respectively. There was no significant difference in survival between the two groups (p\u2009=\u20090.205). Log-rank test revealed that factors predicting poor survival were Child-Pugh B liver function classification, AFP\u2009≥\u2009400\u2009μg/L, intrahepatic multiple tumors, distant metastases, only the TT as the target, a biological effective dose (BED)\u2009<\u200955\u2009Gy and no chance of further radiotherapy.ConclusionsHFRT 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.