Stereotactic Body Radiotherapy in Bulky Hepatocellular Carcinoma with or without Portal Vein Thrombosis: A Feasibility Review in an Egyptian Cohort

Background: Hepatocellular carcinoma (HCC) complicated by portal vein thrombosis presents significant clinical challenges. This study aims to retrospectively assess the feasibility of stereotactic irradiation for treating bulky HCC, with or without vascular invasion.Method: In this retrospective analysis, the radiotherapy treatment plans and clinical follow-up data of ۲۲ patients diagnosed with HCC, with or without portal vein thrombosis, were reviewed. These patients underwent stereotactic body radiation therapy (SBRT) between September ۲۰۱۹ and September ۲۰۲۲. Treatment involved administering ۴۰-۵۰ Gy in ۵ fractions using SBRT with volumetric modulated arc therapy (VMAT)/۴D-computed tomography. Descriptive statistics were utilized without the application of statistical tests.Results: The mean age of the patients was ۶۵ years, with ۷۷% being male. Portal vein thrombosis was present in ۷۳% of the cases, and the average tumor size was ۷.۲ cm (range ۵-۱۲ cm). ۵۹% of patients were classified as Child-Pugh B. The median follow-up duration was ۸ months (range ۳-۳۶ months). At ۳ months, tumor response assessments revealed that ۵۹% of patients had a partial response and ۴۱% had stable disease; by ۶ months, ۳۷% achieved complete response, ۲۶% maintained a partial response, and ۳۷% had stable condition. Failure patterns included intrahepatic failure in two patients (at ۷ and ۹ months) and extrahepatic loss in two others (at ۶ and ۱۰ months). Radiation-induced liver disease occurred in two patients at ۹- and ۱۱-weeks post-treatment, respectively. Liver cancer-specific mortality was ۱۳.۶%, while non-liver cancer-specific mortality stood at ۹%. The progression-free survival rate was ۸۲%.Conclusion: SBRT via VMAT represents a highly cost-effective, non-invasive local therapy with a favorable therapeutic ratio for treating bulky HCC cases, with or without vascular invasion.

Keywords:

Stereotactic , Hepatocellular , Portal , Veins , Thrombosis