Tolerability and efficacy of gamma knife radiosurgery on hepatocellular carcinoma with portal vein tumor thrombosis

// Xiao-Jie Lu 1,* , Jing Dong 2,* , Li-Juan Ji 3,* , Li-Xin Xiao 4 , Chang-Quan Ling 5 and Jun Zhou 6 1 Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China 2 Outpatient Department, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, China 3 Department of Rehabilitation, The Affiliated Huai’an Hospital of Xuzhou Medical College and The Second People’s Hospital of Huai’an, Huai’an, China 4 Department of Gamma Knife, The 411st Hospital of Chinese People’s Liberation Army, Shanghai, China 5 Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China 6 Department of Oncology and Hematology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China * Co-first authors Correspondence to: Jun Zhou, email: // Keywords : hepatocellular carcinoma; portal vein tumor thrombosis; gamma knife; adverse events; overall survival Received : August 14, 2015 Accepted : September 24, 2015  Published : October 14, 2015 Abstract This is a retrospective study on the safety and efficacy of gamma knife radiosurgery (GKR) in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Patients with confirmed HCC and PVTT were allocated into two groups based on the treatments they received (palliative or GKR). A total of 138 patients were included (74 in the palliative group, 64 in GKR group). No significant differences in baseline characteristics existed between the two groups. Treatment-related adverse events (AEs) were recorded and compared between groups. The majority of AEs were mild to moderate and subsided naturally or after medication. There was no AE-induced death. The influences of baseline characteristics and treatment options on patients’ OS were analyzed. The median OS of patients in the palliative and GKR group were 3.0 months (95% CI: 2.719-3.281) and 6.1 months (95% CI: 4.706-7.494) respectively ( p = 0.003). Multivariate analysis revealed that GKR treatment, performance status 0-1, Child A, smaller tumor diameter and monolobar distribution were significant favorable prognosticators. Subgroup analyses showed OS benefit of GKR regardless of PVTT location (main or branch of PVTT). In conclusion, GKR is well tolerated in selected HCC-PVTT patients and can confer OS benefit, which needs validation in future prospective studies.