Transcatheter Hepatic Arterial Chemoem Bolization Followed By Three-dimentional Conformal Radiotherapy For The Treatment Of Primary Hepatic Cancer With Portal Vein Tumor Thrombus

Background and objective: Dissemination trough portal system is a frequent metastasis pathway of primary hepatic cancer(PHC). Portal vein tumor thrombus(PVTT) is a key prognosis factor for patients of PHC. Transcatheter hepatic arterial chemoembolization(TACE) proved to be effective for unresectable or advanced cases. Three-dimentional conformal radiotherapy(3-DCRT) is a new radiotherapy technology well developed in recent years. Tumor tissues could be precisely exposed in high-dose X-rays by 3-DCRT while normal tissues exposed in low-dose rays. Some early PHC could be radical by 3-DCRT. It has been reported 3-DCRT combined TACE could achieve better effects than TACE only for patients of PVTT. So the objective is to investigate the efficacy of transcatheter hepatic arterial chemoembolization(TACE) followed by three-dimentional conformal radiotherapy(3-DCRT) for the treatment of primary hepatic cancer(PHC) with portal vein tumor thrombus(PVTT).Methods: A group of 38 cases of PHC combining with PVTT were treated with TACE followed by 3-DCRT(TACE+3-DCRT group). A control group of 29 cases of PHC combining with PVTT were only treated with TACE(control group). Clinical characters, efficacy, survival state and side-effect were compared between the two groups separately. Statistic analysis was performed by SPSS 10.0 software,α= 0.05 was considered as significant difference standard. Results: In TACE+3-DCRT group, decrease of primary tumor size were observed in 32 cases after 3 months, no change in 4 cases, increase in 2 cases. The complete response of PVTT were observed in 27 cases, partial response in 3 cases, stable disease in 6 cases, progressive disease in 2 cases. For control group, decrease of primary tumor size were observed in 12 cases after 3 months, no change in 9 cases, increase in 8 cases. The complete response of PVTT were observed in 8 cases, partial response in 4 cases, stable disease in 9 cases, progressive disease in 8 cases. There was significant difference between the two groups(P<0.05). For TACE+3-DCRT group, survival time of 8 cases were observed less than 6 months, 11 cases between 6 and 12 months, 19 cases more than 1 year, the median survival time was 12 months. For control group, survival time of 12 cases were observed less than 6 months, 13 cases between 6 and 12 months, 4 cases more than 1 year, the median survival time was 8 months. There was significant difference between the two groups(P<0.05).Conclusions Primary tumor size decreased more significantly after treated 3 months in TACE+3-DCRT group than TACE group. Remission rate of PVTT is higher in TACE+3-DCRT group than TACE group. The survival rate of 1 year is higher in TACE+3-DCRT group than TACE group. The median survival time is longer in TACE+3-DCRT group than TACE group. The incidence rate of adverse reaction is no significantly difference between two groups. In a word, TACE followed by 3-DCRT is more effective than only TACE for the treatment of PHC with PVTT.