Evaluation of clinical efficacy of preoperative radiotherapy for hepatocellular carcinoma with portal vein tumor thrombus

Objective To evaluate the clinical efficacy and application value of preoperative radiotherapy for primary liver cancer (PLC) complicated with portal vein tumor thrombus. Methods Clinical data of 248 patients with PLC complicated with portal vein tumor thrombus admitted to Eastern Hepatobiliary Surgery Hospital from January 2014 to December 2017 were retrospectively analyzed. Among them, 189 patients were male and 59 female, aged 32-82 years with a median age of 53 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into preoperative radiotherapy + surgery group (preoperative radiotherapy group, n=102) and single radiotherapy group (n=146). The clinical efficacy and safety of radiotherapy were evaluated. Survival analysis was performed by nonparametric Wilcoxon test. Results During the period of receiving radiotherapy, most patients suffered from varying degrees of digestive tract reactions, such as nausea, vomiting, anorexia and abdominal distension, etc. No upper gastrointestinal hemorrhage or severe vomiting were observed. All symptoms were relieved after symptomatic treatments. No severe liver damage occurred in any patient. After preoperative radiotherapy at a dose of 18 Gy, 41% (102/248) of the patients obtained the opportunity of undergoing surgery. After radiotherapy, extensive tumor necrosis was observed, portal vein tumor thrombus became localized, hardened and fibrotic. In the preoperative radiotherapy group, the 1-year survival rate was 49%, significantly higher than 32% in single radiotherapy group (Z=44.804, P<0.05). Conclusions Preoperative radiotherapy can reduce the staging of liver cancer patients complicated with portal vein tumor thrombus and obtain the opportunity of surgical resection, which can significantly improve the clinical prognosis and prolongs the overall survival of patients. Key words: Carcinoma, hepatocellular; Radiotherapy; Portal vein; Embolism; Neoplastic cells, circulating