Is hepatocellular carcinoma complicated with portal vein tumor thrombosis potentially curable by radiotherapy in the form of stereotactic body radiation therapy?

Abstract

Purpose

The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal. Despite best treatment and care, the patients with this malignancy only showed 2.7–4 months of overall survival. It is debatable whether liver transplantation helps PVTT sufferers. The effectiveness of radiation therapy in treating HCC patients with PVTT should not be undervalued. By limiting the high dosage region to a small planning target volume, stereotactic radiation delivery has shifted toward hypofractionation, limiting the radiation exposure to healthy organs and tissues. Stereotactic body radiotherapy (SBRT) has a local control rate of 75–100%, depending on the treatment. The major limitation in SBRT for hepatocellular carcinoma with PVTT is the paucity of prospective evidence for longer periods beyond the first two years after treatment. More prospective studies/randomized clinical trials with a longer follow-up, larger sample size, and adequate statistical power are the dire need of the present situation to ascertain the curative effect of SBRT as primary therapy for advanced HCC with PVTT.

Conclusion

SBRT can improve survival, particularly for patients receiving multidisciplinary treatment. This review sums up our most current understanding of how radiation therapy, notably SBRT, can be used to treat hepatocellular carcinoma when combined with PVTT. Recent research has led us to believe that irradiation in the form of SBRT may cure hepatocellular carcinoma complicated by PVTT.

Keywords:

• Hepatocellular carcinoma
• portal vein tumor thrombosis
• three-dimensional conformal radiation therapy
• stereotactic body radiation therapy
• biology

Authors contributions

AS, BJ, and HKP contributed to the conception of the work. All the authors have contributed to the writing of the first draft of the manuscript. BJ reviewed the first draft of the manuscript and provided critical inputs. AS, RK, and BJ substantively revised the drafted manuscript. BJ has overseen the entire work. All authors have read and approved the final manuscript.

Disclosure statement

The authors declare no potential conflict of interest.

Additional information

Funding

HKP has received financial assistance for conducting a pilot study to evaluate the effectiveness and toxicity of SBRT for portal vein thrombosis in patients with advanced hepatocellular carcinoma from the Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi (Grant No. R.11012/16/2018-HR). The authors thank the funding agency for its support.

Notes on contributors

Astha Srivastava

Astha Srivastava, MD, is a Research Associate working in the Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.

Haresh Kunhi Parambath

Haresh Kunhi Parambath, MD, is working as an Additional Professor in the Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.

Anjali V. Ramdulari

Anjali V. Ramdulari, MD, is a Senior Resident working in the Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India

Harsh Saxena

Harsh Saxena, MD, is a Senior Resident working in the Department of Medicine (Trauma), All India Institute of Medical Sciences, New Delhi, India

Rishabh Kumar

Rishabh Kumar, MD is a Senior Resident working in the Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.

Suyash Pandey

Suyash Pandey, MBBS is a Junior Resident working in the Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.

Shalimar

Shalimar, MD is working as an Additional Professor in the Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

Subhash Gupta

Subhash Gupta, MD, is working as an Additional Professor in the Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.

Babban Jee

Babban Jee, Ph.D., is a Scientist working in the Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India.