Michinori Hamaoka1, Tsuyoshi Kobayashi2, Shintaro Kuroda1, Hiroshi Iwako1, Sho Okimoto1, Tomoki Kimura3, Hiroshi Aikata4, Yasushi Nagata3, Kazuaki Chayama5, Hideki Ohdan6. 1. Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan. 2. Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan. Electronic address: tsukoba@hiroshima-u.ac.jp. 3. Department of Radiation Oncology, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan. 4. Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, 734-8553, 1-2-3, Kasumi, Hiroshima, Japan. 5. Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, 734-8553, 1-2-3, Kasumi, Hiroshima, Japan; Liver Research Project Center, Hiroshima University, 734-8553, 1-2-3, Kasumi, Hiroshima, Japan. 6. Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan; Liver Research Project Center, Hiroshima University, 734-8553, 1-2-3, Kasumi, Hiroshima, Japan.
Abstract
BACKGROUND: This study evaluates the survival benefit and safety of hepatectomy after down-staging by 3-dimensional conformal radiation therapy (3D-CRT) for major portal vein tumor thrombus (PVTT) combined with hepatic arterial infusion chemotherapy (HAIC) for advanced hepatocellular carcinoma (HCC). METHODS: Fifty-two patients with unresectable advanced HCC treated with HAIC combined with 3D-CRT for PVTT, from January 2002 to March 2015, were analyzed in this retrospective study. Hepatectomy was offered to patients if, based on radiologic findings, all gross lesions were considered resectable. The safety of hepatectomy was investigated and overall survival (OS) was compared between the resection group (n = 7) and non-resection group (n = 43). RESULTS: OS was significantly higher in the resection group than in the non-resection group. Results of multivariate analysis identified conversion to surgery (hazard ratio, 0.35; 95% confidence interval, 0.10-0.99; P = 0.048) as an independent factor influencing OS. There were no serious postoperative complications and no case of mortality in patients who underwent hepatectomy. CONCLUSIONS: Our findings suggest that hepatectomy after down-staging by 3D-CRT for PVTT combined with HAIC for advanced HCC is safe and results in good long term outcome.
BACKGROUND: This study evaluates the survival benefit and safety of hepatectomy after down-staging by 3-dimensional conformal radiation therapy (3D-CRT) for major portal vein tumor thrombus (PVTT) combined with hepatic arterial infusion chemotherapy (HAIC) for advanced hepatocellular carcinoma (HCC). METHODS: Fifty-two patients with unresectable advanced HCC treated with HAIC combined with 3D-CRT for PVTT, from January 2002 to March 2015, were analyzed in this retrospective study. Hepatectomy was offered to patients if, based on radiologic findings, all gross lesions were considered resectable. The safety of hepatectomy was investigated and overall survival (OS) was compared between the resection group (n = 7) and non-resection group (n = 43). RESULTS: OS was significantly higher in the resection group than in the non-resection group. Results of multivariate analysis identified conversion to surgery (hazard ratio, 0.35; 95% confidence interval, 0.10-0.99; P = 0.048) as an independent factor influencing OS. There were no serious postoperative complications and no case of mortality in patients who underwent hepatectomy. CONCLUSIONS: Our findings suggest that hepatectomy after down-staging by 3D-CRT for PVTT combined with HAIC for advanced HCC is safe and results in good long term outcome.