Hepatocellular carcinoma patients with portal vein thrombosis treated with robotic radiosurgery for long term outcome and analysis: CTRT:2022/01/050234.

Abstract

e16327 Background: A prospective study evaluating the role of stereotactic body radiotherapy (SBRT) with cyber knife (CK) in hepatocellular carcinoma (HCC) with macro-vascular invasion. Methods: Patients with inoperable HCC-PVT, good performance score (PS0-1), and preserved liver function are accrued (CTRI: 2022/01/050234) for treatment on CK version M6 and planned with Multiplan iDMS V2. Triple phase contrast computed tomography scan was done for contouring, and the gross tumor volume included contrast-enhancing mass within main portal vein and adjacent parenchymal disease. Dose prescription as per-risk stratification protocol (22–50 Gy in 5 fractions) achieving the constraints of mean liver dose < 15 Gy, 800 cc liver < 8 Gy, and the duodenum max of ≤24 Gy). Response assessment done at post-CK 2 months for recanalization, evaluation for survival and toxicity outcome done. Results: Between Jan 2017- Dec 2024, 540 consecutive HCC patients were screened and 242 patients with vascular invasion and eligible were accrued in the study [male: 228(94%), female:14(5.8%), mean age 63±8.2, infective etiology 24 (10%), habits: 69(29%), Child Pugh A 183(76%), B:59(24%), adjuvant TKI sorafenib 66(27%), lenvanitib 51(21%)]. Focal disease with portal vein thrombosis PVT 74(31%), liver involvement > 50%: 73(30%), liver involvement in < 50%:93(38%). VP2, VP3, VP4 are 53 (22%), 65(26.9%) and 116 (48%) respectively. In 242 patients accrued, 230 (95%) were evaluable for response assessment (2 months follow-up). At 13 months mean follow up (IQR 4-87), At last follow up, 152(62%) expired and 90 (37%) were alive. 54 patients were alive more than 12 months and 30 patients more than 24 months. Mean estimated OS is 23.9 months (SE 2.44). 1 year & 2 year estimated OS is 75% and 28% respectively. 140(57%) patients had recanalization of PVT response radiologically, 63(26%) patients did not canalize and 5(2%) had progressive disease prior to response evaluation ( < 2 months). Mean overall survival in responders and non-responders were 14.98 months (IQR 5-20) and 10.97 months (IQR 5-12) (p = < 0.001). Median survival in patients with PS0-2 were 10 months (IQR 5-17), 6 months (IQR 3-11) and 7.5 months (IQR 2-15) respectively. Median OS in partial recanalization, bland thrombus and complete recanalization was 9 months (IQR 4-18), 8 months (IQR 4-16) and 19 months (IQR 9-32). 62/242 (26%) patients had RILD; classic 25(10%) and non-classic 37(15%). 5(2%) patients had derangement in Child-Pugh Score by more than one point within 2-month post-CK. Within 2 months, 34(14%) had unplanned admissions, 2 (1%) patients required embolization due to fiducial bleeding, 39 (16%) had ascites. 12(5%) patients required abdomino-centesis and 6 (2.5%) required albumin transfusion. Post-SBRT, 6 (2.5%) patients underwent trans-arterial chemoembolization and 1 (0.4%) trans-arterial radioembolization. Conclusions: PVT response or recanalization after SBRT is a significant prognostic factor for survival function in HCC-PVT.