Three-Dimensional Conformal Radiotherapy Combined With Transarterial Chemoembolization In Primary Liver Cancer With Portal Vein Thrombosis

Purpose:To evaluate the efficacy of three-dimensional conformal radiotherapy(3DCRT) combined with transarterial chemoembolization (TACE),3DCRT alone and TACE alone in advanced primary liver cancer(PLC) with portal vein tumor thrombosis(PVTT) and investigate the prognostic factors.Methods:Between January 2000 and June 2013,182 patients diagnosed by PLC with PVTT were retrospectively analyzed. According to Barcelona staging of liver cancer (BCLC), all patients were BCLC stage C,including 68 patients treated with 3DCRT alone;74 patients treated with TACE alone and 40 patients treated with 3DCRT combined with TACE. Kaplan-Meier method was used to calculate the cumulative survival rates and single-factor analysis. Using a Cox regression (proportional hazards model) method for multiple factors that may affect the prognosis. Tumor response, overall survival rate and toxicity were analyzed.Results:The total effective rate (CR+PR) of all patients was 39.6% (72/182). The median survial time was 8.5 mouths.The survial rates at 1,2,3 and 5 years were 35.4%,14.2%,6.4% and 2.6% respectively. Child-pugh grade, serum AFP level and treatment of 3DCRT combined with TACE are independent prognostic factors influencing survival by Cox regression analysis.There was no significant statistical differences (P> 0.05) between the three treatments in the objective response rate. The patients treated with 3DCRT combined with TACE had a median survial time of 13.2 mouths,which was higher than the patients treated with 3DCRT alone and TACE alone (P<0.05).Conclusions:Child-pugh grade, serum AFP level and treatment of 3DCRT combined with TACE have significant impact on the overall survival in PLC patients with PVTT. There was no significant difference in response rate between the three treatments for PLC with PVTT,but the treatment of 3DCRT combined with TACE can significantly improve long-term survival compared with 3DCRT alone or TACE alone.