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Hepatocellular carcinoma patients with portal vein thrombosis treated with robotic radiosurgery: Interim results of a prospective study

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

This is a prospective study evaluating the role of stereotactic body radiotherapy (SBRT) with CyberKnife (CK) in Indian patients suffering from hepatocellular carcinoma with portal vein thrombosis (HCC-PVT).

Methods

Patients with inoperable HCC-PVT, good performance score (PS), and liver function are accrued for treatment on CK (version M6) and planned with Multiplan (iDMS V2.0). Triple-phase contrast computed tomography (CT) scan was done for contouring, and the gross tumor volume (GTV) included contrast-enhancing mass within main portal vein and adjacent parenchymal disease. Dose prescription was as per-risk stratification protocol (22–50 Gy in 5 fractions) while achieving the constraints of mean liver dose <15 Gy, 800 cc liver <8 Gy, and the duodenum max of ≤24 Gy).

Results

Seventy-two HCC-PVT accrued till date (mean age 63 years [38–76 years], 96% male; Child-Pugh [CP] A 84%, B 9%; Barcelona-Clinic Liver Cancer [BCLC] C 96%; PS0-1: 80%, Karnofsky performance score [KPS]>70: 88%; co-morbidities 42%; infective 12%, alcohol intake 31%, adjuvant sorafenib 39%). CP scores 5, 6, 7, and 8 were in 35%, 32%, 8%, and 18%, respectively. Focal disease with portal vein thrombus (PVT) in 21%, liver involvement >50% and <50% in 46% and 32%. Liver cancer study group of Japan staging–based portal vein invasion VP2, VP3, and VP4 in 22%, 29%, and 40%. Cancer of the Liver Italian Programm (CLIP) scores 1, 2, 3, 4, and 5 were in 8%, 26%, 31%, 26%, and 7%, respectively. Mean follow-up was 7.3 months (median 6 months, standard deviation [SD] 6; range 3–30 months). Mean actuarial overall survival (OS) was 11.4 months (SE 1.587; 95% CI: 8–14.2 months). Six months and 12 months actuarial OS 55% and 38%, respectively. At last follow-up, 25/69 (36%) were alive and 44/69 (64%) were dead. Among 54 patients evaluated for response assessment, 23 (30%) had radiological confirmed PVT response, 1 (3%) had response of IVC thrombus, and 30 (42%) had no or minimal response to SBRT. Actuarial OS in responders and non-responders were 14.4 months (95% CI 9.4–19.2) and 7.4 months (95% CI 4.9–9.7), p-value: 0.022. Six and 12 months survival in responders and non-responders were 65.7% and 37% and 49% and 24.6%, respectively. Post-SBRT, 4 (12%) patients underwent transarterial chemoembolization (TACE) 3 patients (8%) and 1 patient (4%) transarterial radioembolization (TARE). Post-CK, (<4 weeks) 2 patients (4%) had decompensation.

Conclusions

PVT response or recanalization after SBRT is a statistically significant prognostic factor for survival function in HCC-PVT.

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Acknowledgements

We thank Medical and Surgical Gastroenterology unit and Medical Oncology unit of Amrita Institute of Medical Science, Kochi, Kerala, India, for their support.

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Authors and Affiliations

  1. Department of Radiation Oncology, Amrita Institute of Medical Science, Kochi, 682 041, India

    Debnarayan Dutta, Tushar Tatineni, Sreenija Yarlagadda, Ajinkya Gupte, Sruthi K. Reddy, Ram Madhavan, Haridas Nair & Ajay Sasidharan

  2. Department of Radiology, Amrita Institute of Medical Science, Kochi, 682 041, India

    Rajesh Kannan & Shibu G. Pottayil

  3. Department of Medical Physics, Amrita Institute of Medical Science, Kochi, 682 041, India

    Raghavendra Holla

  4. Department of Surgical Gastroenterology, Amrita Institute of Medical Science, Kochi, 682 041, India

    Surendran Sudhindran

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  1. Debnarayan Dutta
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Correspondence to Debnarayan Dutta.

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DD, TT, SY, AG, SKR, RM, HN, AS, RK, SGP, RH, and SS declare no competing interests.

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The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Dutta, D., Tatineni, T., Yarlagadda, S. et al. Hepatocellular carcinoma patients with portal vein thrombosis treated with robotic radiosurgery: Interim results of a prospective study. Indian J Gastroenterol 40, 389–401 (2021). https://doi.org/10.1007/s12664-021-01172-w

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