Objective: To evaluate the clinical effectiveness of a combined treatment consisting of local radiotherapy (external beam radiotherapy, “EBRT”) and transarterial chemoembolization (TACE) for patients with advanced liver tumors with portal vein tumor thrombosis and to identify independent prognostic factors for such patients.
Patients and Methods: From March 2006 to December 2014, 96 patients with unresectable HCC complicated by PVTT were recruited as cases. All subjects received TACE and EBRT. Patient survival was estimated by Kaplan-Meier analysis. In multivariate analyses, the risk of patients’ mortality was estimated by hazard ratio (HR) in Cox proportional hazard regression model.
Results: Mean overall patient survival was 14.8±0.9 months, with 1-year and 2-year survival rates of 40.6% and 14.6%, respectively. Multivariate analyses found that the number of TACE treatments (Hazard ratio [HR]:0.85; 95% confidence interval [CI]:0.75-0.96), maximum tumor diameter [HR: 1.10; 95% CI: 1.02-1.17], and post-TACE objective disease stabilization [HR:0.15; 95% CI:0.07-0.33] to be significantly associated with patient survival. The mean survival time was 22.1±0.97 months of subjects with objective responses to treatment.
Conclusion: Combined TACE and EBRT proved effective and safe for enhancing tumor control in HCC patients with PVTT and achieved a higher response rate and better patient response than single-agent modalities such as chemotherapy, sorafenib, or radiotherapy alone. In addition, only two factors – tumor diameter and the frequency of TACE treatment – were significantly associated with patient survival.