放射联合介入治疗对肝细胞癌伴门静脉癌栓患者的降期作用研究

目的 评估外放射(external-beam radiation therapy, EBRT)联合肝动脉栓塞化疗(transcatheter arterial chemoembolization, TACE)作为肝癌伴门静脉癌栓患者肿瘤降期措施的有效性及安全性。方法 回顾总结上海市东方医院2015年10月至2018年10月间61例行门静脉癌栓放疗联合TACE的原发性肝癌患者的临床资料。放疗形式为三维适形放疗及调强适形放疗,总放射剂量22Gy～48Gy(中位35Gy)。搜集患者年龄、性别、乙肝病毒感染情况、Child分级、AFP、癌栓分型、癌栓疗效、手术方式、术后生存情况等临床信息,统计患者影响预后的危险因素、死亡原因和生存率。结果 门静脉癌栓疗经治疗CR13例,PR17例,SD25例,PD6例。总有效率(CR+PR)为49.2%,患者总体生存时间为3.7～26.8个月,其中位生存时间为11.8个月,平均生存时间为15.9个月。10例癌栓降期患者行手术治疗,手术组中位生存时间分别为17.2个月。多因素回归分析显示癌栓分型、癌栓疗效及是否接受手术治疗对延长术后生存期有利,联合治疗期间不良反...     

肝细胞癌合并门静脉癌栓肝移植治疗进展

肝细胞癌(简称肝癌)易侵犯门静脉系统, 10%～40%肝癌患者在初诊时已合并肉眼可见门静脉癌栓。在欧美国家, 众多肝癌诊治指南将肝癌合并肉眼可见门静脉癌栓定义为进展期肝癌, 故推荐该部分患者进行系统治疗。而在亚洲国家, 外科医师对于肝癌合并门静脉癌栓的处理方式更加积极, 认为其并不是手术绝对禁忌证。目前, 关于肝癌合并门静脉癌栓的治疗, 尚无全球性共识或标准指南。肝移植是不可切除肝癌的根治性治疗措施, 但肝癌合并门静脉癌栓患者行肝移植后肿瘤复发率高, 故肝癌合并门静脉癌栓患者一度被视为肝移植的禁忌证。此外, 肝癌合并门静脉癌栓常被认为存在肿瘤肝外转移。但临床实践中, 在无有效治疗措施的情况下, 越来越多的肝癌合并门静脉癌栓患者转向寻求肝移植并最终成功进行了手术。与此同时, 诸多研究表明在合理选择受体的前提下, 肝移植可以使肝癌合并门静脉癌栓患者生存受益。尤其是同其他治疗方案比较, 在采用降期治疗(包括三维适形放疗、经肝动脉化疗栓塞、立体定向体部放疗、经肝动脉放疗栓塞、经肝动脉灌注化疗等)成功的肝癌合并门静脉癌栓患者中继续行肝移植可使患者获得更佳预后。鉴于肝移植在肝癌合并门静脉癌栓患者中...     

567例不同病理类型的原发性肝癌肝切除术后预后分析

目的 探讨不同病理类型的原发性肝癌患者行肝切除术后的生存状况及临床病理因素对生存的影响,为疾病的预后研究提供参考.方法 回顾性分析1997年1月至2008年12月青岛大学医学院附属医院收治的567例原发性肝癌肝切除术患者的临床资料.按照病理类型将患者分为肝细胞癌、胆管细胞癌、混合型肝癌.分析3种病理类型的肝癌患者的生存情况及影响其预后的危险因素.多组比较采用方差分析,计数资料采用x2检验,计量资料采用t检验,生存分析采用Kaplan-Meier法绘制患者生存曲线,生存情况比较采用Log-rank检验,单因素分析和COX回归模型分析影响患者预后的临床病理因素.结果 567例患者中经病理检查证实为肝细胞癌者占92.9％(527/567),胆管细胞癌者占4.6％ (26/567),混合型肝癌者占2.5％(14/567).肝细胞癌患者中位累积生存时间为48个月,明显长于胆管细胞癌患者的19个月和混合型肝癌患者的14个月,肝细胞癌患者累积生存情况明显优于胆管细胞癌和混合型肝癌患者(Log-rank值为4.354,8.847,P＜0.05);肝细胞癌患者中位无瘤生存时间为26个月,明显长于胆管细胞癌患者的9个月和混合型肝癌患者的9个月,肝细胞癌患者无瘤生存情况明显优于胆管癌细胞癌和混合型肝癌患者(Log-rank值为6.479,7.708,P＜0.05).肝细胞癌患者的1年肿瘤复发率为28.8％(152/527),显著低于胆管细胞癌患者的57.7％(15/26)和混合型肝癌患者的9/14(F=17.046,P＜0.05).胆管细胞癌患者未发现血管癌栓,但区域淋巴结转移率为19.2％(5/26),显著高于肝细胞癌患者的2.8％ (15/527),两者比较,差异有统计学意义(x2=19.082,P＜0.05).AFP、TNM分期、肿瘤直径、病灶数目、肿瘤侵犯肝被膜、卫星灶、区域淋巴结转移等是影响原发性肝癌患者肝切除术后总体生存的因素(x2 =8.648,118.786,59.548,7.639,13.200,43.842,15.540,P＜0.05);血管癌栓和Child-Pugh分级是影响肝细胞癌和混合型肝癌患者总体生存的因素(x2=70.446,6.230,P＜0.05).肝癌患者TNM分期、肿瘤直径、卫星灶、血管癌栓是影响3种病理类型肝癌肝切除术后预后的独立危险因素(RR=1.420,1.050,1.513,1.899,P＜0.05);TNM分期、肿瘤直径和血管癌栓是影响肝细胞癌患者预后的独立危险因素(RR=1.432,1.888,1.052,P＜0.05);TNM分期和肿瘤直径是影响胆管细胞癌患者预后的独立危险因素(RR=1.473,1.503,P＜0.05).结论 虽然胆管细胞癌和混合型肝癌两种病理类型仅占原发性肝癌的少数,但与肝细胞癌患者比较,肝切除术后肿瘤早期复发率高,患者生存率低.     

肝细胞癌合并门静脉癌栓的手术切除及疗效观察

目的 探索肝细胞癌合并门静脉癌栓（ＰＶＴＴ）手术切除的疗效及其影响预后因素。方法 总结近１０年１１１例肝细胞癌合并门静脉主干或第一分支癌栓的患者,均行肝癌联同门静脉左或右支癌栓切除或经左、右支断端取栓或切开主干取栓,其中２２例患者切除肿瘤及癌栓后行肝动脉和（或）门静脉插管。３２例患者术后经肝动脉化疗栓塞和（或）经门静脉导管化疗。另１４例ＰＶＴＴ患者仅行保守治疗（非手术组）,２０例ＰＶＴＴ患者行探查     

原发性肝癌经肝动脉栓塞化疗术后预后指标的多因素分析

目的探讨影响无法手术切除原发性肝癌经肝动脉栓塞化疗(transarterial chemoembolization,TACE)术后预后的独立因素。方法回顾性分析163例行TACE治疗的无法手术切除原发性肝癌患者的临床资料。结果全组均获随访,随访时间为12～63月,平均为(21.8±27.3)月。总体患者TACE术后的1、3、5年累积生存率分别为69.75%、37.49%和21.84%。单因素分析显示,TNM分期、癌灶个数、肿瘤有无假包膜、病灶分布情况、肿瘤大小、门静脉癌栓情况、血清AFP状态、Child-Pugh分级、肿瘤碘油沉积情况及治疗次数与TACE术后生存率显著相关(P均<0.05);经Cox多因素回归分析得出影响肝癌患者TACE术后长期生存的独立预后因素依次为:Child-Pugh分级、术后碘油沉积情况、门静脉癌栓。结论Child-Pugh分级、术后碘油沉积分型及门静脉癌栓是影响TACE术后肝癌患者的独立预后因素。     

原发性肝癌合并门静脉癌栓的外科治疗现状

原发性肝癌并门静脉癌栓 (portalveintumorthrombi,PVTT)发生率为 62 2 %～ 90 2 % [1 ] ,是肝癌治疗中的主要难点之一 ,是肝癌肝内播散及复发的重要因素 ,严重影响患者的预后 ,既往对其多采用消极的方法或放弃治疗 ,大多数患者在数月内死亡。近年来国内外的学者在治疗上进行了积极的探讨 ,取得了一定进展 ,现就目前的治疗手段进行综述。1　肝肿瘤切除并门静脉取栓术　　积极的外科治疗手段 ,主要方法是 :在切除肝癌的同时 ,经肝切除断面的门静脉断端取癌栓或直接切开有癌栓的门脉进行取栓 ,其优点是既切除肝癌 ,又消除癌栓 ,理论上可获…     

原发性肝癌合并癌栓的研究进展

原发性肝癌是由肝细胞或胆管细胞异常增生、分化所形成的恶性肿瘤。影响原发性肝癌预后的一个重要因素是癌栓的形成,所以充分认识癌栓（包括门静脉癌栓和胆管癌栓）对临床的治疗及判断预后尤为重要。笔者就原发性肝癌合并癌栓的研究进展进行综述。     

原发性肝癌伴门静脉癌栓的治疗

目的探讨原发性肝癌(PHC)伴门静脉癌栓的有效治疗方法.方法回顾性分析23例原发性肝癌伴门静脉癌栓患者的临床资料.结果23例均行手术切除肿瘤,并尽可能切除有癌栓的门静脉及从肝断面门静脉内取栓.术后分别采用化疗泵和微量泵化疗,并观察疗效.门静脉主干癌栓8例,死亡2例,6个月内复发4例;门静脉第1级分支癌栓11例,6个月内复发2例,6～12个月内复发6例;小分支癌栓4例,6～12个内复发1例(P<0.01).化疗泵化疗12例,6个月内复发5例,6～12个月内复发4例;微量泵化疗9例,6个月内复发1例,6～12个月内复发3例(P<0.01).结论手术治疗原发性肝癌伴门静脉癌栓有效;术后首选微量泵持续灌注化疗;癌栓部位会影响疗效.     

TACE治疗对肝癌合并门静脉癌栓患者肝切除术后远期生存的影响

目的探讨TACE对肝细胞癌合并门静脉癌栓患者肝切除术后远期生存的影响。方法回顾性分析2003年2月至2010年10月在我院接受肝切除治疗的129例肝细胞癌合并门静脉癌栓患者的临床病理资料,按照术后是否接受辅助性治疗分为TACE组(76例)和非TACE组(53例)。K-M法比较两组患者术后远期生存率,用Cox回归模型分析影响患者术后远期生存的危险因素。通过分层分析比较TACE对不同癌栓类型(参照日本肝癌学习标准:Vp1/2和Vp3/4两组)患者预后的影响。结果 TACE组和非TACE组患者1、2和3年总体生存率分别为:66.7%、74.5%和76.8%vs.71.7%、90.6%、95.3%,差异有统计学意义(P=0.015)。Cox多因素回归结果显示:癌栓分型、肿瘤直径大于5cm、肿瘤多发是影响患者总体生存的独立危险因素,而术后TACE是术后生存的影响因素。分层分析通过K-M曲线和Cox多因素回归结果表明,在Vp1/2型癌栓患者中术后TACE可以提高患者总体生存。结论术后TACE能够提高肝癌合并门脉癌栓患者的远期生存,尤其对于癌栓类型是Vp1和Vp2的患者,术后更应积极实施TACE治疗,从而延长患者生存时间。     

多梳基因Bmi-1在肝癌组织和门静脉癌栓组织中的表达及意义

目的 检测肝癌组织、癌旁肝组织、门静脉癌栓组织和正常肝组织中多梳基因Bmi-1 mRNA及其蛋白的表达,探讨Bmi-1与肝癌患者预后的关系.方法 回顾性分析2005年1月至2009年12月华中科技大学同济医学院附属同济医院收治的40例原发性肝癌患者的临床资料.收集患者手术标本,应用免疫组织化学法、Western blot和实时荧光定量PCR检测Bmi-1 mRNA和蛋白在肝癌组织(40例)、癌旁肝组织(40例)、门静脉癌栓组织(11例)和正常肝组织(10例)中的表达情况,分析Bmi-1与肝癌的临床病理特征关系.组间比较采用Nemenyi检验或Dunnett检验,不同病理因素与Bmi-1蛋白在肝癌组织中的表达差异比较采用x2检验或Fisher确切概率法,采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 正常肝组织、癌旁肝组织、肝癌组织和门静脉癌栓组织中Bmi-1 mRNA的相对表达量中位数分别为0.96、2.60、7.51和29.95.免疫组织化学检测结果提示,正常肝组织、癌旁肝组织、肝癌组织和门静脉癌栓组织中Bmi-1蛋白高表达率分别为10.0％、20.0％、67.5％和100.0％,肝癌组织和门静脉癌栓组织Bmi-1蛋白高表达率均明显高于正常肝组织和癌旁组织(x2=17.25、22.77,22,04、23.95,P＜0.05);Bmi-1蛋白在11例伴有门静脉癌栓的肝癌组织中也呈高表达.Western blot结果与免疫组织化学检测结果相符合.Bmi-1 mRNA及其蛋白的表达与Edmondson分级和门静脉癌栓有关(x2=5.572,P ＜0.05);与肿瘤直径、血清AFP值及HBsAg无关(x2=0.000,0.019,0.663,P＞0.05).术后生存分析结果显示,Bmi-1高表达的患者预后不良.结论 Bmi-1与肝癌的发生、侵袭能力和门静脉癌栓形成有关;Bmi-1高表达比Bmi-1低表达的患者预后差.     

肝移植治疗肝细胞癌合并门静脉癌栓的疗效评价

目的 评价肝移植治疗肝细胞癌合并门静脉癌栓患者的临床应用价值.方法 回顾性分析2002年1月至2006年12月146例行肝移植术治疗肝细胞癌合并门静脉癌栓患者的临床资料,其中10例患者曾行肝切除术,8例患者围手术期死亡,予以排除.对其余128例患者进行了随访,分析影响患者存活率的相关因素.结果 128例肝移植患者术后中位存活时间为13.0个月,术后6个月、1年、2年累积存活率分别为78.1%、51.6%和29.7%.单因素分析表明,癌栓分级、肿瘤大体类型、肿瘤数目是影响患者预后的主要危险因素;多因素分析显示,癌栓分级和肿瘤数目与患者术后累积存活率具有显著的相关性.结论 现阶段肝细胞癌合并门静脉癌栓的患者行肝移植术远期疗效尚不满意,在供者资源严重短缺的条件下应限制应用.     

Predictors of hepatic venous trunk invasion and prognostic factors in patients with hepatocellular carcinomas that had come into contact with the trunk of major hepatic veins

PURPOSE: In this study, we tried to identify the preoperative predictors of hepatic venous trunk invasion and the prognostic factors in patients with hepatocellular carcinoma (HCC) that had come into contact with the trunk of a major hepatic vein over a distance of 1.0 cm or more. METHODS: Forty patients who had such HCCs resected were entered into this study and predictors of hepatic venous trunk invasion and prognostic factors were evaluated by univariate and multivariate analyses. RESULTS AND CONCLUSIONS: A combined resection of the HCC and the venous trunk was performed in 29 patients. Hepatic venous trunk invasion was observed in 12 patients, including 2 with inferior vena cava tumor thrombus. A stepwise logistic regression analysis indicated that tumors larger than or equal to 7 cm in diameter and tumors showing a poorly differentiated histological grade were independent predictors of hepatic venous trunk invasion. The survival of patients without venous trunk invasion was significantly better than that for patients with venous trunk invasion (P = 0.048). A univariate analysis revealed that Child-Pugh classification B (P = 0.002), a high des-gamma-carboxy prothrombin concentration (> or =400 mAU/ml, P = 0.023), a large HCC (> or =5.0 cm in diameter, P = 0.002), the presence of portal vein invasion (P < 0.001), the presence of venous trunk invasion (P = 0.048), the presence of intrahepatic metastasis (P < 0.001), and poorly differentiated HCC (P = 0.006) correlated with a worse overall survival after hepatic resection. In a multivariate analysis, however, only the presence of intrahepatic metastasis (P = 0.037, relative risk 8.25) was an independent predictor of poor overall survival. CONCLUSIONS: Large tumors (> or =7 cm in diameter) and poorly differentiated HCCs were more likely to be associated with hepatic venous trunk invasion and intrahepatic metastasis was an independent prognostic factor in patients with HCC that had come into contact with the trunk of a major hepatic vein.     

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目的 探讨影响肝细胞肝癌手术切除长期生存的预后相关因素。方法 1964～1993年中山大学肿瘤防治中心经手术切除的522例肝细胞肝癌病人，随访至2003年1月，对随访结果进行回顾性分析，计算生存率并作单因素及多因素分析。结果 术后3、5、10和15年累积生存率分别为49．1％、33．8％、16．7％和13．7％；生存5年以上182例，生存10年以上56例，生存15年以上16例。单因素分析结果表明，预后影响因素为性别、术前肝功能Child-Pugh分级、GGT水平、术中肝硬化程度、肿瘤大小、肿瘤数目、有无癌栓、有无卫星结节和是否根治性切除；多因素分析得出影响术后长期生存的预后因素为术前肝功能Child-Pugh分级、GGT水平、术中肝硬化程度、肿瘤大小、有无癌栓和是否根治性切除。结论 肝癌切除术后病人长期生存与否取决于肝病背景、肿瘤情况和治疗因素。术前肝功能Child-PughA级、GGT正常、无或伴轻度肝硬化、肿瘤≤5cm、无癌栓以及行根治性切除的肝癌病人可能获得长期生存。     

肝细胞癌肝内微转移的研究

目的 探讨肝细胞癌肝内微转移分布的规律。方法 选择无临床肝内转移且无门静脉主干或一级分支内瘤栓、切缘充分的单发肝细胞癌切除标本43例为研究对象。用立体定位全取材切片和黑色素瘤抗原（MAGE）及甲胎蛋白（AFP）抗体免疫组化染色技术寻找肝内的微转移。结果 58．7％（25／43）的患者肝内微转移阳性，59．3％（179／302）的转移灶为门静脉内的微瘤栓。微转移距原发灶的最远距离可达4．7cm，P95为2．5cm。单因素分析显示，微转移的发生与血清AFP水平、原发瘤直径、包膜完整性和Edmondson分级相关（χ^2或t值分别为11．50，2．465，12．17和16．59，P〈0．05）。多因素分析显示，原发瘤直径和包膜完整性是独立影响因素（Wald值为7．903和3．858，P〈0．05）。在HE染色微转移阴性的切片中AFP染色阳性率为9．3％，MAGE为7．0％，至少有一项阳性者为14．0％。结论 （1）肝细胞癌肝内转移是较为普遍的现象，大部分位于原发瘤附近，主要形式为门静脉内的微瘤栓。（2）无临床转移的单发肝癌的理想手术切缘应为2．5cm，并应根据肿瘤的生物学特性进行调整。（3）AFP和MAGE免疫组化染色有利于肝内微转移的检出。     

Prognostic benefit of selective portal vein occlusion during hepatic resection for hepatocellular carcinoma

BACKGROUND: The aim of this study was to clarify whether the types of portal vein (PV) occlusion during hepatectomy affect the long-term outcome in patients with hepatocellular carcinoma (HCC). METHODS: Eighty-six patients who had undergone curative hepatic resection for HCC were divided on the basis of the type of PV occlusion into 2 groups: total PV occlusion (TPVO, n = 56) and selective PV occlusion (SPVO, n = 30) groups. The recurrence-free survival was compared between the groups, and factors affecting recurrence-free survival were examined by univariate analyses followed by multivariate analyses. Moreover, the patients with a single nodular HCC less than 5 cm in diameter were abstracted from both groups, and the recurrence-free survival rate was compared. RESULTS: The patients and tumor-related factors were similar in the TPVO and SPVO groups. The recurrence-free survival was better in the SPVO group than in the TPVO group (median recurrence-free survival time, 1520 vs 561 days, P = .017). The type of PV occlusion was a significant factor for recurrence-free survival by univariate analysis but did not reach significance ( P = .052) by multivariate analysis. In the selected patients who had a single nodular HCC less than 5 cm in diameter, the recurrence-free survival was also significantly better in the SPVO group than in the TPVO group (median recurrence-free survival time, 2613 vs 1003 days, P = .018). CONCLUSIONS: Hepatectomy under selective PV occlusion seems to improve the recurrence-free survival in patients with HCC.     

96序列相似的家庭成员B在肝癌的表达及其临床意义

目的:观察96序列相似的家庭成员B(FAM96B)在肝癌组织及癌旁组织中的表达,并探讨其临床意义。方法:收集2012年1月至2013年12月期间在中国人民解放军中部战区总医院接受手术治疗的肝癌患者的组织标本及临床病例资料。采用免疫组织化学技术(IHC)、蛋白质印迹法(Western blot)检测FAM96B在96例肝...     

Microvascular Invasion in Patients with Hepatocellular Carcinoma and Its Predictable Clinicopathological Factors

Background Macroscopic vascular invasion is known to be a poor prognostic factor in hepatocellular carcinoma (HCC). The aim of this study was to determine the outcomes and predictive factors after hepatic resection for HCC with microvascular invasion (MVI). Methods One hundred ten patients who underwent curative resection for HCC without macroscopic vascular invasion were included in this retrospective study. The risk factors of these patients for recurrence-free and disease-specific survival were investigated, and the clinicopathological factors predicting the presence of MVI were also determined. Results Of the 110 resected specimens, 49 (45%) had evidence of MVI. By univariate analysis, MVI was found to be statistically significantly associated with greater tumor size, gross classification, histological grade, and intrahepatic micrometastasis. Gross classification proved to be the only independent predictive factor for MVI by multiple logistic regression analysis. By multivariate analysis, cirrhosis and MVI were identified as independent risk factors for recurrence-free survival. The 5-year recurrence-free survival rates for patients with and without MVI were 20.8% and 52.6%, respectively. By multivariate analysis, the number of tumors, presence of MVI, and intrahepatic micrometastasis were identified as independent predictors of disease-specific survival. The 5-year disease-specific survival rates for patients with and without MVI were 59.3% and 92.0%, respectively. Conclusions The presence of MVI was the most important risk factor affecting recurrence and survival in HCC patients after curative resection. Furthermore, this study showed that gross classification of HCC can be very helpful in predicting the presence of MVI.     

Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature. A European case-control series

Tumor thrombus in major vasculature is a frequent finding with a poor long-term prognosis in patients with hepatocellular carcinoma (HCC). The utility of surgical resection is still controversial. This study compared morbidity and survival after resection for HCC with and without tumor thrombus. Data of 108 patients who underwent major hepatic resection for HCC were prospectively recorded. Patients were divided into two groups. The venous thrombectomy (VT) group included 26 patients who had HCC with tumor thrombus in the portal or hepatic veins. The matched control group included 82 patients who had HCC without tumor thrombus. Surgical technique, early outcome, and late survival were analyzed in each group. Multivariate analysis was performed to assess the prognostic value of this feature. Surgical technique was comparable in the VT and control group with regard to extent of hepatectomy, procedure duration, and transfusion requirements. Early postoperative outcome was also comparable. Actuarial survival at 1, 3, and 5 years was 38%, 20%, and 13%, respectively, in the VT group (median: 9 months) versus 74%, 56%, and 33%, respectively, in the control group (median: 41 months). In the subgroup of patients with tumor thrombus limited to the portal vein, actuarial survival at 1, 3, and 5 years was 50%, 26%, and 17%, respectively, (median: 12 months) and two patients lived longer than 5 years. Multivariate analysis showed that incomplete resection, alphafetoprotein level greater than 100 N, more than two tumor nodules, and tumor thrombus in major vasculature were independent factors of poor prognosis. Survival after resection for HCC with tumor thrombus in the major vasculature is poorer than after resection for HCC without tumor thrombus. However, an aggressive surgical strategy can provide significant survival with comparable morbidity in selected cases, that is, tumor thrombus located in the portal vein only and expected complete resection of the lesions.     

Surgical Resection Versus Conformal Radiotherapy Combined With TACE for Resectable Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Comparative Study

Background

The aim of this study was to compare the results of surgical resection with three-dimensional conformal radiotherapy (3D-CRT) in the treatment of resectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Transarterial chemoembolization (TACE) was given to both groups of patients when possible.

Methods

A retrospective study of 371 patients with resectable HCC with PVTT was conducted in two tertiary referral centers. The treatment of choice for these patients in one center was surgical resection. In the other center it was 3D-CRT. In the radiotherapy group (RG, n = 185), patients received 3D-CRT to the tumor and PVTT for a total radiation dose of 30–52 Gy (median 40 Gy). In the surgical group (SG, n = 186), patients underwent surgical resection. TACE was applied after surgery or 3D-CRT and then was repeated every 4–6 weeks if the patient tolerated the treatment.

Results

The median survival was 12.3 months for RG and 10.0 months for SG. The 1-, 2-, and 3-year overall survivals were 51.6, 28.4, and 19.9 %, respectively, for RG and 40.1, 17.0, and 13.6 %, respectively, for SG (p = 0.029). Stepwise multivariate analysis showed that the extent of PVTT and mode of treatment were independent risk factors of overall survival. The most common cause of death after treatment was liver failure as a consequence of progressive intrahepatic disease.

Conclusions

3D-CRT gave better survival than surgical resection for HCC with PVTT.     

Late urinary morbidity with high dose prostate brachytherapy as a boost to conventional external beam radiation therapy for local and locally advanced prostate cancer

PURPOSE: Late urinary retention (UR) is a known complication that may occur when using high dose rate brachytherapy (HDR-B) to boost external beam radiation therapy (EBRT) when treating prostate cancer. However, the dosimetric, treatment and clinical factors associated with this complication are not well-known. MATERIALS AND METHODS: From March 1997 to March 2000 a total of 108 patients with local or locally advanced prostate adenocarcinoma were treated with EBRT (45 Gy) and HDR-B as a boost, when 16 to 20 Gy was given in 4 fractions twice daily. Median patient age was 68 years and median followup was 44 months (range 36 to 72). Each implant was performed using 8 to 18 needles with a median active length of 3 cm. Planning ultrasound target volume ranged from 23 to 65 cc. RESULTS: Biological effective doses for the urethral region ranged from 107 to 138 Gy3 (median 113). Crude and 5-year actuarial UR-free survival were 95.4% and 86.2%, respectively. Predictive factors for UR on univariate analysis were age more than 65 years (p = 0.0416), planning ultrasound target volume greater than 35 cc and active length of needles more than 3.5 cm (p = 0.0158). On multivariate analysis by Cox regression age was the only predictive factor (p = 0.027). CONCLUSIONS: HDR-B appears to offer a safe, reproducible and effective method of boosting conventional EBRT in patients with locally advanced prostate cancer. Results with this technology reveal late urinary morbidity rates paralleling those achieved with other forms of treatment, but further long-term followup is still needed to warrant a definitive conclusion.