By Will Boggs MD
NEW YORK (Reuters Health) - 1/8/2019
Neoadjuvant three-dimensional conformal radiotherapy (RT) followed by hepatectomy boosts outcomes over those with hepatectomy alone in patients with resectable hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT), researchers from China report.
"We highly recommend introducing a multidisciplinary approach (MDT) in the treatment of HCC with PVTT," said Dr. Shu-Qun Cheng from Eastern Hepatobiliary Surgery Hospital, Navy Military Medical University, in Shanghai.
"The management of HCC with PVTT is extremely complex, and it has to simultaneously address the triple challenges posed by the tumor, severity of PVTT, and liver functional status," he told Reuters Health by email.
The optimal treatment of patients with HCC with PVTT remains controversial. In a previous retrospective study, Dr. Cheng and colleagues found that neoadjuvant RT reduced the extent of PVTT and improved postoperative survival in a proportion of patients.
In their new randomized, open-label study, they compared survival outcomes of neoadjuvant RT followed by hepatectomy versus hepatectomy alone in 164 patients with resectable HCC and PVTT.
Overall survival rates, the primary endpoint, were significantly greater in the neoadjuvant RT group than in the surgery-alone group, with six-month rates of 89.0% versus 81.7%, respectively, 12-month rates of 75.2% versus 43.1%, 18-month rates of 43.9% versus 16.7%, and 24-month rates of 27.4% versus 9.4%.
Disease-free-survival rates were also significantly higher in the neoadjuvant RT group than in the surgery-alone group throughout follow-up, the researchers report in the Journal of Clinical Oncology, online July 8.
RT significantly increased both overall and disease-free survival rates in patients with Cheng's type II PVTT and type III PVTT.
In multivariable analyses, neoadjuvant RT reduced HCC-related mortality by 65% and HCC-recurrence rates by 55%.
Interleukin-6 (IL-6) overexpression in serum and tumor tissues was associated with resistance to RT, suggesting that it might serve as a biomarker to predict the responses to neoadjuvant RT.
The researchers cautioned that the generalizability of their results might be limited because patients with hepatitis C virus-related HCC were excluded from this study.
"In this research, we proved that a considerable proportion of patients was sensitive to radiation and neoadjuvant RT could 'downstage' the PVTT extent in those patients," Dr. Cheng said. "For patients with resectable HCC and PVTT, the combination of neoadjuvant RT and surgery was a potential effective way leading to a better survival."
"For patients with unresectable HCC and PVTT, neoadjuvant RT treatment also may give benefit," he said.
J Clin Oncol 2019.