Preoperative Stereotactic Body Radiotherapy to Portal Vein Tumour Thrombus in Hepatocellular Carcinoma: Clinical and Pathological Analysis
Preoperative Stereotactic Body Radiotherapy to Portal Vein Tumour Thrombus in Hepatocellular Carcinoma: Clinical and Pathological Analysis
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DOI：
10.1038/s41598-020-60871-0
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发表时间：
2020-03-05
影响因子：
4.6
通讯作者：
Teshima, Teruki
中科院分区：
文献类型：
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作者：
Kishi, Noriko;Kanayama, Naoyuki;Teshima, Teruki
肝细胞癌合并门静脉肿瘤血栓（PVTT）预后较差。我们进行了一项前瞻性研究，以评估三模式治疗的有效性和安全性，包括术前立体定向体放疗（SBRT）和手术，然后肝动脉输注化疗（HAIC）治疗HCC合并PVTT患者。在本报告中，我们研究了切除病例中PVTT标本的病理和sbrt相关的急性毒性。2012 - 2016年，我院共8例肝癌PVTT患者接受术前靶向PVTT的4次SBRT治疗，剂量48Gy。在这8名患者中，6名接受了手术，而其余2名因疾病进展而没有接受手术。病理检查中，所有患者PVTT辐照标本均出现坏死组织，6例患者中有3例病理反应完全。2例患者坏死30%伴高度退变，1例患者坏死30%无退变，是随访期间唯一复发病例（中位：22.5个月，范围：5.9-49.6个月）。从SBRT到手术，没有观察到SBRT相关的急性毒性低于2级。总之，术前SBRT治疗HCC在病理上是有效的，急性毒性是可耐受的。
The prognosis of hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) is poor. We conducted a prospective study to evaluate the efficacy and safety of tri-modality therapy, including preoperative stereotactic body radiotherapy (SBRT) and surgery, followed by hepatic arterial infusion chemotherapy (HAIC) in HCC patients with PVTT. In this report, we investigated the pathology of the irradiated PVTT specimen in resected cases and SBRT-related acute toxicity. A total of 8 HCC patients with PVTT received preoperative SBRT targeting the PVTT at a dose of 48Gy in 4 fractions at our institute from 2012 to 2016. Of the eight patients, six underwent surgery, while the remaining two did not because of disease progression. At the pathological examination, all patients' irradiated PVTT specimens showed necrotic tissue, and three of six patients showed complete pathological response. Two patients showed 30% necrosis with high degeneration and one patient, with 30% necrosis without degeneration, was the only recurrent case found during the follow-up period (median: 22.5, range: 5.9-49.6 months). No SBRT-related acute toxicity worse than grade 2 was observed from SBRT to surgery. In conclusion, the preoperative SBRT for HCC was pathologically effective and the acute toxicities were tolerable.