| Part 1The efficacy of three-dimensional conformal radiotherapy(3D-CRT)compared to hepatic resection(HR)for small hepatocellular carcinoma(HCC).Objective: The aim of this study is to evaluate the efficacy of 3D-CRT in small hepatocellular carcinoma.Methods: Between January 2000 and December 2014,201 patients diagnosed with small HCC were included in this study.The study groups were47 HCC patients treated with 3D-CRT(RT group)and 154 controls treated with hepatic resection(HR group).To reduce confounding bias between the groups,propensity score matching(PSM)was conducted.Kaplan-Meier and Cox regression analysis were used to compare overall survival(OS)and progression-free survival(PFS)rates.Subgroup analysis based on tumor size and the hepatic sclerosis was also carried out.Results: The 1-,3-,5-year PFS rates of the RT group were 87%?49%?36%,and those of the HR group were 84%?63%?58%,repectively,p=0.041.The 1-,3-,5-year OS rates of the RT group were 92%,62% and51%,and those of the HR group were 92%,80% and 58%,repectively,p=0.020.However,After PSM,the OS rates of the two groups were similar,and for the patients with smaller tumors and those who uncomplicated hepatic cirrhosis(all p>0.05).Multivariate analyses revealed that Child-Pugh class B,AFP?400ng/mL and complicated hepatic cirrhosis are independent predictors of poor prognosis in small HCC patients.Conclusion: 3D-CRT and HR are similar in the treatment of small HCC.3D-CRT can be used as the first choice of treatment.Part 2A comparison of chemoembolization combination with and without radiotherapy for unresectable HCCBackground and Objective: This study evaluated the efficacy and safety of TACE combined with 3D-CRT on the objective response rates and survival of patients with unresectable HCC.Methods: Between January 2000 and December 2014,we retrospectively studied 181 patients with unresectable HCC in this study.The study groups were103 HCC patients treated with TACE combined with 3D-CRT(RT group)and78 controls treated with TACE alone(non-RT group).To reduce confounding bias between the groups,PSM was also conducted.Tumor response rate was analyzed and compared between the two groups.Kaplan-Meier and Cox regression analysis were used to compare OS and failure patterns.Result: The objective response rate of tumor was higher in the RT group(70% vs 31%,p< 0.001).The 1-,3-,5-year OS rates of the RT group were 80%,30% and 17%,and those of the non-RT group were 53%,18% and12%,repectively,p=0.006.RT group provided a better survival over non-RT group.Propensity scoring analyses also showed that RT group was associated with better objective responses and survival than non-RT group.Cox multivariate analyses revealed that multiple nodules,Child-Pugh class B,AFP?400ng/mL are independent predictors of poor prognosis in patients with unresectable HCC.Intrahepatic failure was similar in the RT and non-RT groups.Side effects from radiotherapy were rarely severe.Conclusion: TACE combined with 3D-CRT can significantly improve long-term survival compared with TACE alone.The outcome of unresectable HCC can be influenced by 3D-CRT.Part 3The efficacy of 3D-CRT compared to HR for in advanced HCC with portal vein tumor thrombosis(PVTT).Objective: The purpose of this study is to evaluate the safety and efficacy of 3D-CRT for advanced HCC with PVTT.Methods: We retrospectively studied 323 advanced HCC patients with PVTT between January 2000 and December 2014.The study groups were 134 HCC patients treated with 3D-CRT(RT group)and 189 controls treated with HR(HR group).In order to reduce confounding bias between the groups,PSM was conducted.Kaplan-Meier and Cox regression analysis were used to compare OS.Moreover,subgroup analysis based on portal vein tumor thrombosis type and combination of TACE was carried out.Results: The 1-,3-,5-year OS rates of the RT group were 54%?18%and 8%,and those of the HR group were 62%?43 % and 32%,repectively,p=0.003.However,the OS rates of the two groups were similar after PSM(p=0.058).In the subgroup of PVTT type analyze,The 1-,2-,3-year OS of patients treated with RT was significantly worse than those treated with HR in type ? PVTT(p<0.001).However,the OS rates of the two groups were similar in type ? PVTT(p=0.612).Moreover,the OS rates of patients treated with RT was significantly better than those treated with HR in type ? PVTT(p=0.041).Multivariate analyses revealed that tumor size ?10 cm,Child-Pugh class B and type ? PVTT are independent predictors of poor prognosis in HCC patients with PVTT.Conclusion: 3DCRT and HR are similar in the treatment of advanced HCC with PVTT.3DCRT can be used as the first choice of in type ?/? PVTT of HCC. |
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