Hepatocellular carcinoma patients with portal vein thrombosis treated with robotic radiosurgery for long term outcome and analysis: CTRT:2022/01/050234.
Year: 2025
Type: conference-abstract
Abstract: e16327 Background: A prospective study evaluating the role of stereotactic body radiotherapy (SBRT) with cyber knife (CK) in hepatocellular carcinoma (HCC) with macro-vascular invasion. Methods: Patients with inoperable HCC-PVT, good performance score (PS0-1), and preserved liver function are accrued (CTRI: 2022/01/050234) for treatment on CK version M6 and planned with Multiplan iDMS V2. Triple phase contrast computed tomography scan was done for contouring, and the gross tumor volume included contrast-enhancing mass within main portal vein and adjacent parenchymal disease. Dose prescription as per-risk stratification protocol (22–50 Gy in 5 fractions) achieving the constraints of mean liver dose < 15 Gy, 800 cc liver < 8 Gy, and the duodenum max of ≤24 Gy). Response assessment done at post-CK 2 months for recanalization, evaluation for survival and toxicity outcome done. Results: Between Jan 2017- Dec 2024, 540 consecutive HCC patients were screened and 242 patients with vascular invasion and eligible were accrued in the study [male: 228(94%), female:14(5.8%), mean age 63±8.2, infective etiology 24 (10%), habits: 69(29%), Child Pugh A 183(76%), B:59(24%), adjuvant TKI sorafenib 66(27%), lenvanitib 51(21%)]. Focal disease with portal vein thrombosis PVT 74(31%), liver involvement > 50%: 73(30%), liver involvement in < 50%:93(38%). VP2, VP3, VP4 are 53 (22%), 65(26.9%) and 116 (48%) respectively. In 242 patients accrued, 230 (95%) were evaluable for response assessment (2 months follow-up). At 13 months mean follow up (IQR 4-87), At last follow up, 152(62%) expired and 90 (37%) were alive. 54 patients were alive more than 12 months and 30 patients more than 24 months. Mean estimated OS is 23.9 months (SE 2.44). 1 year & 2 year estimated OS is 75% and 28% respectively. 140(57%) patients had recanalization of PVT response radiologically, 63(26%) patients did not canalize and 5(2%) had progressive disease prior to response evaluation ( < 2 months). Mean overall survival in responders and non-responders were 14.98 months (IQR 5-20) and 10.97 months (IQR 5-12) (p = < 0.001). Median survival in patients with PS0-2 were 10 months (IQR 5-17), 6 months (IQR 3-11) and 7.5 months (IQR 2-15) respectively. Median OS in partial recanalization, bland thrombus and complete recanalization was 9 months (IQR 4-18), 8 months (IQR 4-16) and 19 months (IQR 9-32). 62/242 (26%) patients had RILD; classic 25(10%) and non-classic 37(15%). 5(2%) patients had derangement in Child-Pugh Score by more than one point within 2-month post-CK. Within 2 months, 34(14%) had unplanned admissions, 2 (1%) patients required embolization due to fiducial bleeding, 39 (16%) had ascites. 12(5%) patients required abdomino-centesis and 6 (2.5%) required albumin transfusion. Post-SBRT, 6 (2.5%) patients underwent trans-arterial chemoembolization and 1 (0.4%) trans-arterial radioembolization. Conclusions: PVT response or recanalization after SBRT is a significant prognostic factor for survival function in HCC-PVT.
Source: Journal of Clinical Oncology
Authors: Hema Ashok Perumal, Sruthi K Reddy, Haridas M N, Ajay Sasidharan, Rajesh Kannan, Shibu George, Nikhil Krishna Haridas, Wesley Mannirathil Jose, Pavithran Keechilat, Rakesh MP, Arun Valsan, Anoop Koshy, Rajesh Gopalakrishnan, Shine Sadasivan, Unnikrishnan Gopalakrishnan, Dhinesh Balakrishnan, Sudheer OV, Sudhindran S, Debnarayan Dutta
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4410812579