Surgical Resection Versus Conformal Radiotherapy Combined With TACE for Resectable Hepatocellular Carcinoma With Portal
- PDF / 331,735 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 12 Downloads / 168 Views
Surgical Resection Versus Conformal Radiotherapy Combined With TACE for Resectable Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Comparative Study Qing-he Tang • Ai-jun Li • Guang-ming Yang • Eric C.H. Lai • Wei-ping Zhou • Zhi-hao Jiang Wan Yee Lau • Meng-chao Wu
•
Published online: 1 March 2013 Ó Socie´te´ Internationale de Chirurgie 2013
Abstract Background The aim of this study was to compare the results of surgical resection with three-dimensional conformal radiotherapy (3D-CRT) in the treatment of resectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Transarterial chemoembolization (TACE) was given to both groups of patients when possible. Methods A retrospective study of 371 patients with resectable HCC with PVTT was conducted in two tertiary referral centers. The treatment of choice for these patients in one center was surgical resection. In the other center it was 3D-CRT. In the radiotherapy group (RG, n = 185), patients received 3D-CRT to the tumor and PVTT for a total radiation dose of 30–52 Gy (median 40 Gy). In the surgical group (SG, n = 186), patients underwent surgical resection. TACE was applied after surgery or 3D-CRT and then was repeated every 4–6 weeks if the patient tolerated the treatment. Results The median survival was 12.3 months for RG and 10.0 months for SG. The 1-, 2-, and 3-year overall survivals were 51.6, 28.4, and 19.9 %, respectively, for RG Q. Tang A. Li E. C.H.Lai W. Zhou (&) W. Y. Lau M. Wu The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China e-mail: [email protected] W. Y. Lau e-mail: [email protected] G. Yang Z. Jiang Navy No. 411 Hospital of Shanghai, Shanghai 200438, China e-mail: [email protected] E. C.H.Lai W. Y. Lau Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
123
and 40.1, 17.0, and 13.6 %, respectively, for SG (p = 0.029). Stepwise multivariate analysis showed that the extent of PVTT and mode of treatment were independent risk factors of overall survival. The most common cause of death after treatment was liver failure as a consequence of progressive intrahepatic disease. Conclusions 3D-CRT gave better survival than surgical resection for HCC with PVTT.
Introduction Patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) have an extremely poor prognosis. For patients who receive no treatment, the reported median survival was 2.7–4.0 months [1–4]. When the PVTT extends to the main portal vein, the prognosis is extremely bad because (1) shedding of HCC cells along the portal vein may result in extensive intrahepatic metastases; (2) complete obstruction of the main portal vein causes further deterioration in liver function and liver failure; and (3) there is aggravation of portal hypertension with resultant intractable ascites and esophageal bleeding [5]. The management of these patients is still controversial [5, 6]. PVTT is a contrai
Data Loading...
