Analysis of the prognostic and related factors in hepatocellular carcinoma patients with portal vein thrombosis after radiotherapy

• Main Authors: Yueh-chun Lee, 李岳駿
• Other Authors: 張文瑋
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/t7t868

碩士 === 中山醫學大學 === 生物醫學科學學系碩士班 === 102 === BACKGROUND Hepatocellular carcinoma（HCC）is the second most common malignancies in Taiwan. Patients with HCC who had portal vein or inferior vena cava tumor thrombosis （PVT or IVCT） are considered as poorer treatment outcomes and radiotherapy （RT） is main treatment for those patients. In cancer radiotherapy, safety margin should be added around gross tumor volume （GTV） to overcome uncertainties in planning or treatment delivery. To clarify prognostic factors, safety and quality of RT in those patients is important for further therapeutic design. METHODS Patients with HCC who had PVT or IVCT and received RT were enrolled in this study. Demographic variables, laboratory values, tumor characteristics, and RT modalities were determined before and post RT. The primary end point was overall survival. Predicted factors of survival were identified using the univariate and multivariate analysis. Calculation of planning target volume （PTV） was used to evaluate the safety margin. The imaging records of TomoTherapy in treatment of abdomen or pelvic tumors were used to evaluate daily different directions motion of liver. RESULTS Ten patients with HCC who had PVT or IVCT received RT between April 2009 and October 2012 were enrolled. Overall median survival in partial response group was 14.1 months versus 4.3 months in stable or progress group （p =0.001）. Pretreatment unfavorable predictors were advanced stage, old age, positive of HBsAg, higher AST（aspartate aminotransferase） and poorer Child–Pugh classification. Post treatment unfavorable predictors were higher total biliribum, lower albumin, higher AST （95% confidence interval, p <0.05）. GTV safety maximal margin at different directions of X（right/left）, Y（up/down）, Z（in/out） were 4mm, 8mm and 8mm, respectively. Daily random motion of abdomen or pelvic tumor treatment, mean value at different directions of X, Y and Z were 3.01mm, 2.8mm and 3.14mm, respectively. Conclusions The results will help in understanding the potential factors that influence survival for patients with HCC after RT. Radiotherapy is effective for PVT or IVCT. Careful add adequate margin could safely overcome daily motions.