1
|
BAIA M, NAUMANN DN, WONG CS, MAHMOOD F, PARENTE A, BISSACCO D, ALMOND M, FORD SJ, TIROTTA F, DESAI A. Dealing with malignancy involving the inferior vena cava in the 21st century. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:664-673. [DOI: 10.23736/s0021-9509.22.12408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
2
|
Wu G, Huang G, Huang J, Lu L, Peng S, Li Y, Zhao W. Comparison of External Beam Radiation Therapy Modalities for Hepatocellular Carcinoma With Macrovascular Invasion: A Meta-Analysis and Systematic Review. Front Oncol 2022; 12:829708. [PMID: 35242713 PMCID: PMC8887617 DOI: 10.3389/fonc.2022.829708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/24/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose We performed a systematic review and meta-analysis to compare external beam radiation therapy modalities for hepatocellular carcinoma (HCC) with macrovascular invasion (MVI). Methods Studies were selected from online databases from the date of inception to November 2021. The outcomes of interest were overall survival (OS), objective response rate (ORR), and local control rate (LCR). Results Forty-four studies (n = 3730) were selected from 1050 articles. The pooled 1-year OS were 60.9%, 45.3%, and 44.9 for particle radiotherapy (PRT) group, conventional radiotherapy (CRT), and stereotactic body radiotherapy (SBRT) group, respectively; p = 0.005 and 0.002 for PRT vs. CRT and SBRT, respectively. Both the PRT group and the SBRT group have the advantage over the CRT group in the pooled ORR. The PRT group showed significantly higher than the CRT group (p = 0.007) in LCR. For combination therapy, CRT plus transarterial chemoembolization can prolong survival than CRT alone (p = 0.006 for 1-year OS; p = 0.014 for 2-year OS). Among grade ≥ 3 complications, the most frequent type of toxicity in CRT, SBRT, PRT group was hematological toxicity, hepatotoxicity, dermatological toxicity, respectively. Conclusions Among patients with HCC with MVI, the 1-year OS and the 2-year OS were both higher in the PRT group than in the CRT, SBRT groups. The ORR was similar between the PRT and SBRT groups. The combination therapy based on radiotherapy is expectable. PRT is associated with less complications than photon radiotherapy.
Collapse
Affiliation(s)
- Guanheng Wu
- Zhuhai Precision Medical Center, Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Jinan University, Zhuhai, China
| | - Guomin Huang
- Zhuhai Precision Medical Center, Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Jinan University, Zhuhai, China
| | - Jianwen Huang
- Zhuhai Precision Medical Center, Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Jinan University, Zhuhai, China
| | - Ligong Lu
- Zhuhai Precision Medical Center, Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Jinan University, Zhuhai, China
| | - Shaojun Peng
- Zhuhai Precision Medical Center, Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Jinan University, Zhuhai, China
| | - Yong Li
- Zhuhai Precision Medical Center, Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Jinan University, Zhuhai, China
| | - Wei Zhao
- Zhuhai Precision Medical Center, Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Jinan University, Zhuhai, China
| |
Collapse
|
3
|
Chen ZH, Zhang XP, Feng S, Feng JK, Chai ZT, Guo WX, Shi J, Lau WY, Meng Y, Cheng SQ. Liver resection versus intensity-modulated radiation therapy for treatment of hepatocellular carcinoma with hepatic vein tumor thrombus: a propensity score matching analysis. Hepatobiliary Surg Nutr 2021; 10:646-660. [PMID: 34760968 DOI: 10.21037/hbsn.2020.03.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/13/2020] [Indexed: 12/16/2022]
Abstract
Background The presence of hepatic vein tumor thrombus (HVTT) is a major determinant of survival outcomes in hepatocellular carcinoma (HCC) patients. This study compared survival outcomes between liver resection (LR) and intensity-modulated radiation therapy (IMRT) in HCC patients with HVTT. Methods Data from patients who underwent LR or IMRT for HCC with HVTT at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed. Their survival outcomes were compared before and after propensity score matching (PSM). Results Three hundred and seven HCC patients with HVTT who underwent either LR (n=140) or IMRT (n=167) were enrolled. PSM matched 82 pairs of patients. The overall survival (OS) and recurrence-free survival (RFS) rates were significantly higher for patients in the LR group than those in the IMRT group. On subgroup analysis, significantly better survival outcomes were obtained after LR than IMRT in patients with peripheral type of HVTT (pHVTT) and major type of HVTT (mHVTT). However, similar survival outcomes were obtained after LR and IMRT when the HVTT had developed into inferior vena cava tumor thrombus (IVCTT). Conclusions LR resulted in significantly better survival outcomes in HCC patients with HVTT when compared to IMRT. Once the HVTT had developed IVCTT, LR and IMRT resulted in similarly bad survival outcomes.
Collapse
Affiliation(s)
- Zhen-Hua Chen
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xiu-Ping Zhang
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.,Department of Hepatobiliary and Pancreatic Surgical Oncology, The First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Shuang Feng
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jing-Kai Feng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Zong-Tao Chai
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wei-Xing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wan Yee Lau
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.,Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yan Meng
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
4
|
Tanaka M, Komatsu S, Kido M, Toyama H, Tominaga M, Uchida Y, Terashima K, Demizu Y, Okimoto T, Fukumoto T. Salvage hepatectomy for local recurrence after particle therapy using proton and carbon ion beams for liver cancer. Ann Gastroenterol Surg 2021; 5:711-719. [PMID: 34585055 PMCID: PMC8452475 DOI: 10.1002/ags3.12468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
AIM With the increased use of particle therapy for liver cancer, local recurrence after particle therapy increased. Salvage hepatectomy is an acceptable treatment option for local recurrence following particle therapy; however, its safety and effectiveness remain unclear. Therefore, this multi-center study aimed to verify the feasibility and efficacy of salvage hepatectomy and assess clinical issues associated with its application. METHODS We retrospectively assessed the perioperative outcomes, prognosis, and pathological characteristics of 15 patients who underwent salvage hepatectomy for local recurrence after particle therapy between 2006 and 2019. RESULTS Hepatocellular carcinoma and metastatic liver tumors were noted in eight and seven patients, respectively. The mean total dose and number of fractions were 66.5 Gy and 12, respectively, and the mean interval between particle therapy and surgery was 30.1 months. Major hepatectomy was performed in seven cases. Moreover, the mortality rate was 0%, and surgical complications of Clavien-Dindo grade IIIa or higher were observed in four cases (27%)-two bile leakages, one pleural effusion, and one refractory skin fistula. The median overall survival time and 5-year overall survival rate after salvage hepatectomy were 29.9 months and 43.1%, respectively. Histological examination of the irradiated liver tissue surrounding the tumor showed sinusoidal dilatation, loss of hepatocyte, and fibrosis in most cases. CONCLUSION Salvage hepatectomy after particle therapy is a feasible therapy; however, the risk of refractory complications associated with particle therapy is relatively high. Therefore, the first-line treatment for resectable liver cancer should be carefully determined considering second-line treatment after local recurrence.
Collapse
Affiliation(s)
- Motofumi Tanaka
- Division of Hepato‐Biliary‐Pancreatic SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Shohei Komatsu
- Division of Hepato‐Biliary‐Pancreatic SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Masahiro Kido
- Division of Hepato‐Biliary‐Pancreatic SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Hirochika Toyama
- Division of Hepato‐Biliary‐Pancreatic SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Masahiro Tominaga
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Yoichiro Uchida
- Department of Gastroenterological Surgery and OncologyThe Tazuke Kofukai Medical Research InstituteKitano HospitalOsakaJapan
| | - Kazuki Terashima
- Department of RadiologyHyogo Ion Beam Medical CenterTatsunoJapan
| | - Yusuke Demizu
- Department of RadiologyHyogo Ion Beam Medical CenterTatsunoJapan
- Department of Radiation OncologyHyogo Ion Beam Medical Center Kobe Proton CenterKobeJapan
| | - Tomoaki Okimoto
- Department of RadiologyHyogo Ion Beam Medical CenterTatsunoJapan
| | - Takumi Fukumoto
- Division of Hepato‐Biliary‐Pancreatic SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| |
Collapse
|
5
|
Alrashidi I, Chu HH, Kim JH, Shim JH, Yoon SM, Kim PH, Gwon DI, Ko HK. Combined Chemoembolization and Radiotherapy Versus Chemoembolization Alone for Hepatocellular Carcinoma Invading the Hepatic Vein or Inferior Vena Cava. Cardiovasc Intervent Radiol 2021; 44:1060-1069. [PMID: 33745071 DOI: 10.1007/s00270-021-02815-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of transarterial chemoembolization (TACE) plus radiotherapy compared with TACE alone for patients with hepatocellular carcinoma (HCC) invading the hepatic vein (HV) or inferior vena cava (IVC). MATERIALS AND METHODS Data from 79 patients who underwent TACE plus radiotherapy as a first-line treatment for non-metastatic HCC invading the HV or IVC between 2006 and 2018 were retrospectively evaluated. These findings were compared with data from a historical control group, consisting of 80 patients who received TACE alone between 2000 and 2006. RESULTS Baseline characteristics were similar in both groups. Median progression-free survival (PFS) (8.1 vs. 4.4 months, P = 0.003) and overall survival (OS) (18.3 vs. 9.5 months, P = 0.002) were longer in the TACE plus radiotherapy than in the TACE alone group. Multivariate analysis showed that PFS and OS were significantly associated with treatment type. Subgroup analyses found that TACE plus radiotherapy showed better OS than TACE alone in patients with Child-Pugh class A, maximal tumor size < 9 cm, tumor number < 4, serum alpha-fetoprotein level ≥ 400 ng/mL, infiltrative tumor, IVC tumor thrombus, and combined portal vein invasion. The major complication rates were similar between the TACE plus radiotherapy (16.5%) and the TACE alone (13.8%) group (P = 0.664) CONCLUSION: Both TACE plus radiotherapy and TACE alone showed similar safety in treating non-metastatic HCC invading the HV or IVC. TACE plus radiotherapy seems effective to prolong OS and PFS compared to TACE alone in this specific patient group.
Collapse
Affiliation(s)
- Ibrahim Alrashidi
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine , 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine , 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine , 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
| | - Ju Hyun Shim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Medical Center, Asan Liver Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine , 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine , 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine , 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| |
Collapse
|
6
|
Lee D, Komatsu S, Terashima K, Toyama H, Matsuo Y, Takahashi D, Suga M, Nishimura N, Tai K, Kido M, Demizu Y, Tokumaru S, Okimoto T, Sasaki R, Fukumoto T. Surgical spacer placement for proton radiotherapy in locally advanced pancreatic body and tail cancers: initial clinical results. Radiat Oncol 2021; 16:3. [PMID: 33407648 PMCID: PMC7788736 DOI: 10.1186/s13014-020-01731-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background Particle radiotherapy has increasingly gained acceptance for locally advanced pancreatic cancers owing to superior tumor conformity and dosimetry compared to conventional photon radiotherapy. However, the close proximity of the pancreas to the stomach and duodenum leads to radiation-induced gastrointestinal toxicities, which hinder the delivery of curative doses to the tumor. To overcome this problem, a surgical spacer was placed between the tumor and gastrointestinal tract, and subsequent proton radiotherapy was performed in this study. Methods Data from 9 patients who underwent surgical spacer placement and subsequent proton radiotherapy were analyzed. The safety and feasibility of the spacer placement surgery were evaluated; the impact of the spacer on dosimetry was also assessed using dose volume histogram (DVH) analyses, before and after surgical spacer placement. Results Surgical spacer placement and subsequent proton radiotherapy were successfully completed in all cases. Surgical spacer placement significantly improved the dose intensity covering 95%, mean, and minimum doses for the gross tumor volume, and the clinical and planning target volume based on the DVH, while respecting the dose constraints of the gastrointestinal tract. Based on the Common Terminology Criteria for Adverse Events, two patients (22.2%) developed gastrointestinal ulcer (Grade 2) at 1 and 35 months, and one patient (11.1%) developed gastric perforation (Grade 4) at 4 months after proton radiotherapy. Conclusions Surgical spacer placement in the locally advanced pancreatic body and tail cancers is relatively safe and technically feasible. Comparing radiation plans, surgical spacer placement seems to improve the dose distribution in the locally advanced pancreatic body and tail cancers, which are close to the gastrointestinal tract.
Collapse
Affiliation(s)
- Dongha Lee
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Kazuki Terashima
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yoshiro Matsuo
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Daiki Takahashi
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Masaki Suga
- Department of Radiation Physics, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Naoko Nishimura
- Department of Radiation Technology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Kentaro Tai
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Masahiro Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan.,Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, 1-6-8, Minatojimaminami-machi, chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Sunao Tokumaru
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| |
Collapse
|
7
|
Lee HA, Rim CH. Efficacy of Local Treatments for Hepatocellular Carcinoma Involving the Inferior Vena Cava and/or Right Atrium. J Hepatocell Carcinoma 2020; 7:435-446. [PMID: 33376712 PMCID: PMC7762452 DOI: 10.2147/jhc.s285357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
Major vessel invasion is frequently observed in locally advanced hepatocellular carcinoma (HCC). The most commonly involved major vessel is the portal vein; however, approximately 4% of patients with HCC have inferior vena cava (IVC) and/or right atrium (RA) invasion. Although these conditions have dismal prognoses, local treatments have not been regularly administered because they may affect systemic circulation. Owing to recent technological advances, various local treatments including surgery and external radiotherapy have increasingly been performed in these patients. Since irradiating tumorous lesions in the liver while preserving normal tissues is possible and major vessels are relatively resistant to radiation, external radiotherapy has been a feasible palliative modality for treating vessel-invasive HCC. In addition, systemic fatal complications that were initially a cause of concern have become rare after radiotherapy. While invasive procedures such as extracorporeal circulation or hepatic vascular exclusion may be required, pioneering surgeons have performed surgical resections in selected patients and have obtained promising results. Surgery has shown the best survival outcomes compared to other treatment options including radiotherapy, but the possibility of perioperative morbidity should be considered. In addition, a combination of local treatment and novel systemic agents, which demonstrated better survival and response rates than sorafenib, is expected to maximize therapeutic effects. In this review, we have discussed the most recent treatments for HCC with IVC and/or RA involvement and have provided information intended to guide therapeutic decisions and facilitate future research.
Collapse
Affiliation(s)
- Han Ah Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University Medical College, Seoul, Republic of Korea
| | - Chai Hong Rim
- Department of Radiation Oncology, Korea University Ansan Hospital, Korea University Medical College, Ansan, Gyeonggido, Republic of Korea
| |
Collapse
|
8
|
Lee HA, Park S, Seo YS, Yoon WS, Shin I, Rim CH. Surgery versus external beam radiotherapy for hepatocellular carcinoma involving the inferior vena cava or right atrium: A systematic review and meta‐analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:1031-1046. [DOI: 10.1002/jhbp.865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Han Ah Lee
- Department of Gastroenterology Korea University Anam Hospital Korea University Medical College Seoul Korea
| | - Sunmin Park
- Department of Radiation Oncology Korea University Ansan Hospital Korea University Medical College Ansan Korea
| | - Yeon Seok Seo
- Department of Gastroenterology Korea University Anam Hospital Korea University Medical College Seoul Korea
| | - Won Sup Yoon
- Department of Radiation Oncology Korea University Ansan Hospital Korea University Medical College Ansan Korea
| | - In‐Soo Shin
- Graduation School of Education Dongguk University Seoul Korea
| | - Chai Hong Rim
- Department of Radiation Oncology Korea University Ansan Hospital Korea University Medical College Ansan Korea
| |
Collapse
|
9
|
Shi F, Wang C, Kong Y, Yang L, Li J, Zhu G, Guo J, Zheng Q, Zhang B, Wang S. Assessing the Survival Benefit of Surgery and Various Types of Radiation Therapy for Treatment of Hepatocellular Carcinoma: Evidence from the Surveillance, Epidemiology, and End Results Registries. J Hepatocell Carcinoma 2020; 7:201-218. [PMID: 33117754 PMCID: PMC7585265 DOI: 10.2147/jhc.s272813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the survival benefit of surgery and radiation for hepatocellular carcinoma (HCC) after adjusting for patient-specific and tumor-specific factors. Methods This study analyzed HCC patients who enrolled in the Surveillance, Epidemiology, and End Results (SEER) registry between January 2004 and December 2013. Of the 5552 HCC patients, 4597 received surgery and 955 received radiation. Patients who received radiation were further divided into 3 subgroups: 541 who received beam radiation (BR), 197 who received radioactive implants (RI), and 217 who received radioisotopes (RIT). Propensity score weighting analysis derived from generalized boosted models (GBMs) was performed to ensure well-balanced characteristics in all comparison groups. Results Overall survival rates and HCC-specific survival rates were higher in those receiving surgery compared with those receiving radiotherapy. This was confirmed by Cox proportional hazard regression both before and after inverse probability of treatment weighting (IPTW). Before IPTW, the RIT group had a better outcome than the BR group in terms of overall and HCC-specific survival rates, but there was no significant difference between the RI and BR groups. After IPTW, Cox proportional hazard regression demonstrated that both the RIT and RI groups had higher survival rates than the BR group. Conclusion In HCC patients, surgery was associated with higher survival rates compared with radiotherapy while adjusting for other factors. Among those who received radiotherapy, RIT and RI granted survival benefits.
Collapse
Affiliation(s)
- Fuyan Shi
- Department of Health Statistics, School of Public Health, Weifang Medical University, Weifang, Shandong 261053, People's Republic of China
| | - Chen Wang
- Department of Computer Science, Rutgers University, Piscataway, NJ 08854, USA
| | - Yujia Kong
- Department of Health Statistics, School of Public Health, Weifang Medical University, Weifang, Shandong 261053, People's Republic of China
| | - Liping Yang
- Center for Health and Medicine, Xijing Hospital, an Affiliated Hospital of Air Force Military Medical University, Xi'an, Shannxi 710032, People's Republic of China
| | - Juan Li
- Department of Health Statistics, School of Public Health, Weifang Medical University, Weifang, Shandong 261053, People's Republic of China
| | - Gaopei Zhu
- Department of Health Statistics, School of Public Health, Weifang Medical University, Weifang, Shandong 261053, People's Republic of China
| | - Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, People's Republic of China
| | - Qingfeng Zheng
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Suzhen Wang
- Department of Health Statistics, School of Public Health, Weifang Medical University, Weifang, Shandong 261053, People's Republic of China
| |
Collapse
|
10
|
Shiba S, Shibuya K, Okamoto M, Okazaki S, Komatsu S, Kubota Y, Nakano T, Ohno T. Clinical impact of Hypofractionated carbon ion radiotherapy on locally advanced hepatocellular carcinoma. Radiat Oncol 2020; 15:195. [PMID: 32795340 PMCID: PMC7427730 DOI: 10.1186/s13014-020-01634-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) involving a major branch of the portal or hepatic vein is in a locally advanced stage and remains difficult to cure. This study aimed to evaluate the clinical effects of carbon ion radiotherapy (C-ion RT) in locally advanced HCC (LAHCC). Methods The data of 11 consecutive patients with LAHCC who received C-ion RT were analyzed. The C-ion RT doses of 52.8 Gy (relative biological effectiveness [RBE]) and 60.0 Gy (RBE) were delivered in 4 fractions for standard cases, and the 60.0 Gy dose was delivered in 12 fractions for close-to-gastrointestinal-tract cases. Survival and local control probabilities were calculated using the Kaplan-Meier method. Results The median follow-up duration after C-ion RT was 36.4 months. The median age at the time of registration for C-ion RT was 76 years. The median tumor size was 53 mm. The numbers of treatment-naive and recurrent HCC patients were 1 and 10, respectively. Direct invasion of the major branch of the portal vein, hepatic vein, or both portal and hepatic veins was observed in three, five, and three patients, respectively. The 3-year overall survival, local control, and progression-free survival rates were 64, 78, and 18%, respectively. No patient developed radiation-induced liver diseases or grade 3 or higher toxicities in the acute and late phases. Conclusions C-ion RT showed favorable clinical outcomes with a high rate of local control and minimal toxicities in LAHCC. Our findings suggest that C-ion RT is a promising multidisciplinary treatment option in LAHCC.
Collapse
Affiliation(s)
- Shintaro Shiba
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan. .,Gunma University Heavy Ion Medical Center, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Kei Shibuya
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Gunma University Heavy Ion Medical Center, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Masahiko Okamoto
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Shohei Okazaki
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Shuichiro Komatsu
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoshiki Kubota
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| |
Collapse
|
11
|
Xia Y, Zhang J, Ni X. Diagnosis, treatment and prognosis of hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus. Oncol Lett 2020; 20:101. [PMID: 32831920 PMCID: PMC7439153 DOI: 10.3892/ol.2020.11962] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
Although tumor thrombus (TT) infringement of the inferior vena cava (IVC) and right atrium (RA) is rarely observed in hepatocellular carcinoma (HCC), the prognosis for this condition is extremely poor, with a median survival time of several months, given that the condition is often diagnosed at an advanced tumor stage or combined with multiple systemic metastases. Furthermore, there is no established effective treatment for the condition. However, some investigators insist that active treatment, including surgery, chemotherapy (systemic or intra-arterial), radiation therapy, best supportive care or a combination of these, may help prolong overall survival time in these patients. The management of patients with advanced HCC and a TT extending into the RA and IVC is extremely difficult and risky. To this end, the present review assessed the literature on the clinical features and treatments of this condition in recent years, with the aim of providing assistance for clinical work.
Collapse
Affiliation(s)
- Yinchuan Xia
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
| | - Junqi Zhang
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
| | - Xiaoling Ni
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
| |
Collapse
|
12
|
Tomita K, Shimazu M, Takano K, Gunji T, Ozawa Y, Sano T, Chiba N, Abe Y, Kawachi S. Resection of recurrent hepatocellular carcinoma with thrombi in the inferior vena cava, right atrium, and phrenic vein: a report of three cases. World J Surg Oncol 2020; 18:138. [PMID: 32571339 PMCID: PMC7310451 DOI: 10.1186/s12957-020-01914-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background Prognosis for patients with advanced hepatocellular carcinoma with a tumor thrombus in the inferior vena cava or right atrium is extremely poor due to cancer progression, pulmonary embolism, and congestion of the circulatory system caused by right heart failure. Surgical resection of the tumor thrombi may potentially yield better results than non-surgical treatments through prevention of sudden death. However, the benefits of surgical resection in patients with hepatocellular carcinoma and a tumor thrombus extending to the inferior vena cava, right atrium, and potentially in the phrenic vein are unclear. Here, we report three such cases. Case presentation Of the total 136 patients who underwent hepatectomies for hepatocellular carcinoma in our institution, three patients with prior hepatectomies and recurrent hepatocellular carcinoma had tumor thrombi in the inferior vena cava, right atrium, and phrenic vein. Surgical resections were performed, as there was a possibility of sudden death, despite the risk of leaving residual tumor. For all patients, we performed resection of the tumor thrombi in the inferior vena cava and right atrium and combined diaphragm resection. Surgical resection was performed using the total hepatic vascular exclusion technique in all cases. Additional passive veno-venous bypass was also performed in two cases, in which complete tumor resections could not be achieved. The microscopic surgical margins of the combined resected diaphragms were positive in all cases. Progression-free survival was 20.2, 3.8, and 9.5 months for case 1, 2, and 3, respectively. The respective overall postoperative survival was 98.0, 38.9, and 30.9 months. The patients died due to liver cirrhosis, acute heart failure, and hepatocellular carcinoma, respectively. Sudden death did not occur for any of the patients. Conclusion Surgical resections may extend prognosis for patients with recurrent hepatocellular carcinoma with tumor thrombi in the inferior vena cava, right atrium, and phrenic vein, although the indications should be considered carefully.
Collapse
Affiliation(s)
- Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Motohide Shimazu
- Department of Surgery, Tama Kyuryo Hospital, 1491 Shimooyamada, Machida-shi, Tokyo, 194-0297, Japan
| | - Kiminori Takano
- Department of Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka-shi, Kanagawa, 254-0065, Japan
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Yosuke Ozawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan.
| |
Collapse
|
13
|
Nomogram for Predicting Long-Term Survival after Synchronous Resection for Hepatocellular Carcinoma and Inferior Vena Cava Tumor Thrombosis: A Multicenter Retrospective Study. JOURNAL OF ONCOLOGY 2020; 2020:3264079. [PMID: 32322268 PMCID: PMC7168703 DOI: 10.1155/2020/3264079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/08/2020] [Indexed: 02/05/2023]
Abstract
Background Although surgery for hepatocellular carcinoma (HCC) complicated with inferior vena cava tumor thrombus (IVCTT) may improve survival for some patients, prognostic markers remain elusive because of its rarity. We constructed a prognostic nomogram which predicts individualized survival benefit of curative-intent surgery for HCC patients with IVCTT. Methods According to abdominothoracic anatomy of inferior vena cava (IVC), IVCTT can be divided into 3 types: inferior diaphragmic (ID), superior diaphragmic (SD), and intracardiac type (IC). Data of 64 HCC patients with IVCTT who underwent curative-intent surgery between 2008 and 2015 in four centers in China were analyzed retrospectively. Univariate and multivariate Cox regression analyses were conducted to select variables for the construction of a prognostic nomogram. Predictive accuracy and discriminative ability were examined by concordance index (C-index) and calibration curve. Results Of 64 patients in the IVCTT classification, 37 (57.8%) were classified as ID type, 15 (23.4%) as SD type, and 12 (18.8%) as IC type. The 1-, 2-, 3-, and 5-year disease-specific survival (DSS) rates for patients in ID, SD, and IC groups were 94.4%, 55.6%, 71.4%, and 30.0%; 27.8%, 21.4%, 7.1%, and 0%; and 8.3%, 0%, 0%, and 0%, respectively. Independent factors included in the nomogram were ECOG performance status, AFP level ≥ 400 μg/L, tumor size ≥ 10 cm, portal vein tumor thrombosis, and IVCTT classification. The C-index of the nomogram was 0.812 (95% CI 0.761–0.873). The calibration plot for DSS probability showed excellent agreement between the prediction by nomogram and actual observation. Conclusions Curative-intent surgery should be carefully evaluated and suggested according to our novel IVCTT classification. We have developed a visual web-based nomogram model to predict oncological prognosis of curative-intent surgery for HCC patients with IVCTT.
Collapse
|
14
|
Sekino Y, Okumura T, Fukumitsu N, Iizumi T, Numajiri H, Mizumoto M, Nakai K, Nonaka T, Ishikawa H, Sakurai H. Proton beam therapy for hepatocellular carcinoma associated with inferior vena cava tumor thrombus. J Cancer Res Clin Oncol 2019; 146:711-720. [PMID: 31776663 DOI: 10.1007/s00432-019-03096-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus (IVCTT) is rare and regarded as an advanced disease stage with poor prognosis. Treatment effect data regarding HCC with IVCTT is scarce and clear evidence has not been established. This study, therefore, aims to examine the safety and effectiveness of proton beam therapy (PBT) for HCC patients with IVCTT. METHODS From January 2005 to December 2014, a total of 21 HCC patients with IVCTT were analyzed. The total irradiation doses ranged from 50 to 74 (median 72.6) gray relative biological effectiveness. RESULTS The follow-up period was 4-120 (median 21) months. Regarding acute toxicities, dermatitis of grade 1-2 was observed in all patients, while no grade 3 or higher late toxicity events were encountered. The overall survival (OS) rates for all patients were 62%, 33%, and 19% at 1, 2, and 3 years, respectively. No local recurrences for the treated lesions, including IVCTT, were observed. According to univariate analysis, IVCTT extension type was not associated with prognosis, but only tumor number significantly affected the OS rate (p = 0.003). For 10 single lesion patients, the longest survival time was 120 months with OS rates of 82%, 64%, and 36% at 1, 2, and 3 years, respectively. CONCLUSION PBT is safe and effective for HCC patients with IVCTT, especially those with single lesion status. PBT is an important treatment option for HCC patients with IVCTT.
Collapse
Affiliation(s)
- Yuta Sekino
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan.
| | - Toshiyuki Okumura
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Nobuyoshi Fukumitsu
- Kobe Proton Center, 1-6-8 Minatojima Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Takashi Iizumi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Kei Nakai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Tetsuo Nonaka
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| |
Collapse
|