Introduction
Methods
Patients
Radiotherapy
Response assessments and follow-up
Statistical methods
Results
Patient characteristics
Characteristic | No. of patients (%) |
---|---|
Age (years) | |
Median | 63 |
Range | 40–92 |
Gender | |
Male | 29 (69.0) |
Female | 13 (31.0) |
ECOG performance status | |
0 | 4 (9.5) |
1 | 23 (54.8) |
2 | 14 (33.3) |
3 | 1 (2.4) |
Child-Pugh class | |
A | 25 (59.5) |
B | 15 (35.7) |
C | 2 (4.8) |
Etiology of chronic liver disease | |
HBV | 24 (57.1) |
HCV | 11 (26.2) |
HBV & HCV | 3 (7.1) |
Others | 4 (9.5) |
Thrombus site besides IVCa | |
Right atrium | 11 (26.2) |
Portal vein | 16 (38.1) |
Hepatic vein | 15 (35.7) |
LN metastasis | |
Absent | 34 (81.0) |
Present | 8 (19.0) |
Lung metastasis | |
Absent | 32 (76.2) |
Present | 10 (23.8) |
Treatment characteristics
Treatment | No. of patients (%) |
---|---|
Previous treatmenta | |
None | 15 (35.7) |
Operation | 10 (23.8) |
TACE/TAE | 19 (45.2) |
RFA/PEI | 11 (26.2) |
Systemic treatment | 12 (28.6) |
Treatment concurrent with RTb | |
None | 13 (31.0) |
Operation | 0 (0.0) |
TACE/TAE | 12 (28.6) |
RFA/PEI | 1 (2.4) |
Systemic treatment | 24 (57.1) |
Treatment after RTc | |
None | 20 (47.6) |
Operation | 4 (9.5) |
TACE/TAE | 6 (14.3) |
RFA/PEI | 1 (2.4) |
Systemic treatment | 21 (50.0) |
RT technique | |
3DCRT | 7 (16.7) |
IMRT | 35 (83.3) |
RT dose (EQD10/2, Gy)d | |
Median (range) | 48.75 (3.25–67.10) |
< 50 | 22 (52.4) |
≥ 50 | 20 (47.6) |
No. of patients (%) | |||
---|---|---|---|
Systemic therapy | Pre-R/T | During RT | Post-R/T |
Total | 12 (28.6) | 24 (57.1) | 21 (50.0) |
Sorafenib | 12 (28.6) | 17 (40.5) | 16 (38.1) |
Nivolumab | 1 (2.4) | 2 (4.8) | 2 (4.8) |
Thalidomide | 0 (0.0) | 4 (9.5) | 1 (2.4) |
Tegafur/uracil | 0 (0.0) | 1 (2.4) | 0 (0.0) |
Ramucirumab | 0 (0.0) | 0 (0.0) | 3 (7.1) |
Everolimus | 0 (0.0) | 0 (0.0) | 1 (2.4) |
Pegargiminase | 0 (0.0) | 0 (0.0) | 1 (2.4) |
IVC response and survival outcomes
Variable | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
HR (95% CI) | P value | HR (95% CI) | P value | |
Age (< 65 vs. ≥65 years) | 0.709 (0.350–1.434) | 0.338 | ||
Gender (female vs. male) | 0.748 (0.502–1.114) | 0.153 | ||
ECOG performance status (2–3 vs. 0–1) | 1.656 (1.138–2.410) | 0.008 | 1.175 (0.365–3.776) | 0.787 |
Child-Pugh class (B&C vs. A) | 2.123 (1.472–3.062) | 0.000 | 2.411 (1.073–5.414) | 0.033 |
Right atrium invasion (yes vs. no) | 1.330 (0.905–1.952) | 0.146 | ||
Portal vein invasion (yes vs. no) | 1.961 (1.343–2.864) | 0.000 | 1.086 (0.662–1.782) | 0.743 |
Hepatic vein invasion (yes vs. no) | 0.970 (0.662–1.422) | 0.876 | ||
LN metastasis (yes vs. no) | 1.926 (1.232–3.010) | 0.004 | 2.118 (1.171–3.831) | 0.013 |
Lung metastasis (yes vs. no) | 1.509 (1.000–2.276) | 0.050 | 1.751 (1.064–2.883) | 0.028 |
Systemic treatmenta (without vs. with) | 2.430 (1.625–3.634) | 0.000 | 1.346 (0.680–2.667) | 0.394 |
RT dose (EQD10/2, Gy)b (<50 vs. ≥50) | 1.583 (1.100–2.280) | 0.013 | 1.050 (0.669–1.649) | 0.832 |
Objective response of IVCc (no vs. yes) | 2.326 (1.552–3.488) | 0.000 | 2.604 (1.544–4.391) | 0.000 |
Lung metastasis and pulmonary embolism
Variable | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
HR (95% CI) | P value | HR (95% CI) | P value | |
Age (< 65 vs. ≥65 years) | 0.745 (0.344–1.617) | 0.457 | ||
Gender (female vs. male) | 0.664 (0.284–1.552) | 0.344 | ||
ECOG performance status (2–3 vs. 0–1) | 4.069 (1.665–9.943) | 0.002 | 3.337 (0.895–12.440) | 0.073 |
Child-Pugh class (B&C vs. A) | 3.336 (1.475–7.543) | 0.004 | 2.847 (0.867–9.354) | 0.085 |
Right atrium invasion (yes vs. no) | 2.134 (0.906–5.028) | 0.083 | ||
Portal vein invasion (yes vs. no) | 2.614 (1.109–6.162) | 0.028 | 1.149 (0.406–3.250) | 0.794 |
Hepatic vein invasion (yes vs. no) | 0.973 (0.436–2.172) | 0.947 | ||
LN metastasis (yes vs. no) | 4.360 (1.415–13.429) | 0.010 | 1.016 (0.248–4.171) | 0.982 |
Systemic treatmenta (without vs. with) | 3.263 (1.332–7.988) | 0.010 | 2.463 (0.919–6.600) | 0.073 |
RT dose (EQD10/2, Gy)b (<50 vs. ≥50) | 2.171 (0.962–4.896) | 0.062 | ||
Objective response of IVCc (no vs. yes) | 3.471 (1.498–8.042) | 0.004 | 5.732 (1.906–17.235) | 0.002 |
Patterns of failure
Disease | No. of patients (%) |
---|---|
Site of first progression | |
IVC thrombus | 3 (7.2) |
Liver | 9 (21.5) |
Distant metastasis | 21 (50.0) |
Lung | 14 (33.3) |
Brain | 3 (7.1) |
Bone | 2 (4.8) |
Others | 2 (4.8) |
Cause of death | |
Liver failure | 11 (33.3) |
Lung metastasis | 7 (21.2) |
Pulmonary embolism | 2 (6.1) |
Variceal bleeding | 2 (6.1) |
Duodenal ulcer bleeding | 2 (6.1) |
Pneumonia | 2 (6.1) |
SBP | 2 (6.1) |
Brain metastasis | 1 (3.0) |
Acute renal failure | 1 (3.0) |
CVA | 1 (3.0) |
Unknown | 2 (6.1) |