Session Item

Upper GI (oesophagus, stomach, pancreas, liver)
Digital Poster
Clinical
Indian experience of 100 HCC patients with portal vein thrombosis treated with robotic radiosurgery
Debnarayan Dutta, India
PO-1215

Abstract

Indian experience of 100 HCC patients with portal vein thrombosis treated with robotic radiosurgery
Authors:

Debnarayan Dutta1, Sruthi K Reddy1, Yarlagadda Sreenija1, Haridas M Nair1, Ajay Sasidharan1, Ajinkya Gupte1, Rajesh Kannan2, Shibu G Pottayil2, Annex Edappattu3, Sudhindran S4

1Amrita Institute of Medical Sciences, Radiation Oncology, Kochi, India; 2Amrita Institute of Medical Sciences, Radiology, Kochi, India; 3Amrita Institute of Medical Sciences, Medical Physics, Kochi, India; 4Amrita Institute of Medical Sciences, Surgical Gastroenteology, Kochi, India

Show Affiliations
Purpose or Objective

Analysis from a prospective study evaluating the role of Stereotactic body radiotherapy (SBRT) with CyberKnife (CK) in Indian patients suffering from hepatocellular carcinoma with portal vein thrombosis (HCC-PVT).

Material and Methods

Patients with inoperable HCC-PVT, good performance score(PS) and liver function are accrued for treatment on CK (version M6) and planned with Multiplan (iDMS V2.0). Triple-phase contrast computed tomography (CT) scan was done for contouring and the gross tumor volume (GTV) included contrast enhancing mass within main portal vein and adjacent parenchymal disease. Dose prescription was as per risk stratification protocol (22-50Gy in 5 fractions) while achieving the constraints of mean liver dose <15Gy, 800 cc liver <8Gy and the  duodenum max of <24 Gy).

Results

Between Jan 2017 till Dec 2020, 100 consecutive HCC with PVT patients (pt) were accrued [male 97(97%), CP A 66%, CP B 30%, mean age 61.4 years (38-77yrs), CLIP 0-2: 29 (29%), CLIP 3-6 69 (69%), infective etiology 10%, PS0-1 81% ]. In 100 consecutive patients accrued, 70 were evaluable for response assessment (>3 mo follow up). Mean survival was 7.91 mo (3 mo-30 mo), 54 patients expired and 41 were alive. 28 (40%) patients had recanalization of PVT (response), 36 (51%) pts did not recanalize, 3 (4%)pt had progressive disease and 3 (4%) did not have response evaluation. Mean overall survival in responders and non-responders were 10.57 and 6.47 month respectively (p-0.001). Mean survival in patients with PS0, PS1 and PS2 were 16.5, 11 and 10.1 mo (p-0.039) respectively. Alcohol intake had a trend towards significance (9.3 Vs 14.6 mo; p-0.089). Adjuvant sorafenib, BCLC stage, gender, age, RT dose did not influence response to treatment. Among these 70 evaluable pts, 17pt (24%) had RILD [6 (8%) had Classic RILD & 11 (16%) had non-classic RILD]. CP score assessment at 2 month follow up, 38 (54%) had no change in CP score. Decline of 1, 2 & 3  point  CP score from baseline was in 9 (13%), 12 (17%), 13 (19%) pts. Improvement in CP score from baseline in 7(10%). Among 100 patients who underwent fiducial placement, decompensation occurred in 15 patients (15%), 5(5%) had post-fiducial bleed and 1 patient (1%) required embolization. At Post-CK3 month decline from Grade A to B in 20 (28%) and C in 2 (2%). Decline from grade B to C in 4 (6%).

Conclusion

PVT response or recanalization after SBRT is a statistically significant prognostic factor for survival function in HCC-PVT.