981P - The response of portal vein tumoral thrombosis to moderately hypo-fractionated radiotherapy using intensity modulated radiotherapy

Background

Hepatocellular carcinoma (HCC) has a high incidence and mortality worldwide, particularly in Africa and East Asia, due to the widespread hepatitis B and C viral infections (1). Locally advanced HCC is frequently associated with vascular invasion, commonly affecting the portal vein, with an incidence of portal vein tumor thrombosis (PVTT) ranging from 31.4 to 34% (2). PVTT is associated with poor clinical outcomes, including deterioration of hepatic function, tumor dissemination, and shorter overall survival (3). Treatment options for HCC with PVTT are limited. Radiation therapy (RT) has an important role in the management of HCC, from palliative to curative intent. (4).

Methods

Fifty patients with PVTT in HCC were prospectively treated with IMRT using moderately hypofractionated doses. A statistical analysis of the patient's survival and radiotherapy (RT) response was done. Potential prognostic factors for response to RT and survival were assessed.

Results

The median survival for 50 patients was 10 months, with a 1-year survival rate of 36% and a response rate of 36%. Response to treatment, Eastern Cooperative Oncology Group Performance Status (ECOG PS), hepatic focal lesion size, and Child-Pugh score were statistically significant prognostic factors for survival in univariate analysis (P = <0.001, P = 0.001, P = 0.007, and P = <0.001, respectively). Among these factors, Child-Pugh score, ECOG PS, and response to treatment were significant for patient prognosis in multivariable analysis (P = 0.003, P = 0.012, and P = 0.023, respectively).

Conclusions

As patients with PVTT usually have a poor prognosis and short survival, using hypofractionated RT regimens with short-course treatment can improve survival in these patients. RT responders can be elected for treatment with another local treatment modality with a chance for better overall survival.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Minia University.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.