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TACE plus radiotherapy improves survival for HCC, portal vein tumor thrombus

The use of transarterial chemoembolization with radiotherapy led to improved survival outcomes for patients with unresectable hepatocellular carcinoma and portal vein tumor thrombus, compared with patients who underwent transarterial chemoembolization alone, per published findings in Hepatology Research.

“In recent years, transarterial chemoembolization has become the most popular palliative treatment for patients with unresectable HCC, and it is no longer considered as a contraindication to HCC with [portal vein tumor thrombus (PVTT)]. However, the effect of TACE alone on PVTT is not satisfactory,” Xiao-Long Li, of Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China, and colleagues wrote.

Researchers evaluated 112 patients with HCC and PVTT undergoing TACE combined with radiotherapy and 735 patients undergoing TACE alone. Additional pairs of patients were selected from each treatment arm (n = 108) and matched with patients from the original cohort by using a propensity score matching analysis.

The researchers found that patients who underwent combined therapy with TACE and radiotherapy had a longer median survival rate compared with patients treated with TACE alone (11 months vs. 4.8 months; P < .001). This was even more apparent in patients with PVTT involving the right/left portal vein (12.5 months vs. 5.2 months; P < .001) and main portal vein trunk (8.9 months vs. 4.3 months; P < .001), per the research.

The propensity score matching analysis showed the median survival time was 10.9 months vs. 4.1 months among all patients (P < .001); 12.5 months vs. 4.4 months among patients with PVTT involving the right/left portal vein (P = .002); and 8.9 months vs. 4 months among patients with PVTT involving the main portal vein trunk (P < .001).

In univariate analysis of overall survival for all patients, treatment with TACE plus radiotherapy, maximum lesion diameter of 5 cm or less, the absence of main trunk PVTT and AFP of 400 ng/mL or less were associated with increased survival.

Cox proportional hazards model showed four independent prognostic predictors for poor survival: TACE alone treatment (P < .001), maximum lesion diameter of more than 5 cm (P < .001), the presence of main trunk PVTT (P = .001) and AFP of more than 400 ng/mL (P = .015).

“TACE combined with RT has become an option for the non-surgical treatment of HCC with PVTT,” the researchers concluded. “Our study shows that combination therapy yields a more promising outcome in patients with HCC and PVTT, especially in patients with PVTT involving the right/left portal vein or main trunk.” – by Melinda Stevens

Disclosure: Helaio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.