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Stereotactic radiosurgery for palliative management of hepatocellular carcinoma associated with portal vein thrombosis
Background
The life expectancy and treatment options for the patients with hepatocellular carcinoma HCC presented with portal vein thrombosis are frustrating. This study aimed at evaluating the efficacy and safety of stereotactic radiosurgery SRS as a palliative treatment for this group of patients.
Methods
Between January 2020 and March 2021, we examined patients who are ineligible for local treatment of HCC (i.e., radiofrequency RF, trans- arterial chemotherapy TACE, or even liver transplantation) because they were diagnosed to have portal vein thrombosis PVT. We offered those patients SRS as palliative treatment. The selected dose of SRS was 40 Gy in 5 fractions while sparing ≥ 700 cc of the liver tissue. Patients should have ECOG performance status of 1-2 with no or minimal ascites and total bilirubin of ≥ 2.5 mg/dl.
Results
During the study period, 16 patients were enrolled, 12 were males, and only 4 were females. The median age of those patients was 62.4 years (range 48 to 72 years). They were all having Child- Pugh B or early C (7-9). All the patients had suffered from portal vein thrombosis PVT (of the main portal vein or one of its branches). The 6 months overall survival OS was 87.5%, and the radiological response rate RR (stable disease and decreased tumour size) was found in 75% of cases (12/16) by the 3 months follow up. The thrombosed portal vein showed radiological signs of recanalization in 50% of treated patients. Those patients showed reduced levels of alpha fetoprotein and improved levels of local pain compared to the pre-treatment levels. None experienced grade 4 adverse events. By the time of data analysis (September 2021) 8 patients were still alive.
Conclusions
SRS as a palliative treatment for advanced HCC is safe and effective in patients with good performance status. Such results need validation with multicentre randomized studies that would recruit more patients with longer follow up.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
