Clinical Research Papers:
Should transarterial chemoembolization be given before or after intensity-modulated radiotherapy to treat patients with hepatocellular carcinoma with portal vein tumor thrombus? a propensity score matching study
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Xiaolong Li1,2,*, Weixing Guo1,*, Lei Guo1,*, Wan Yee Lau1,3, Naijian Ge1, Kang Wang1 and Shuqun Cheng1
1Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
2Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, China
3Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
*These authors have contributed equally to this work
Shuqun Cheng, email: [email protected]
Keywords: hepatocellular carcinoma; portal vein tumor thrombus; radiotherapy; transarterial chemoembolization
Received: June 01, 2017 Accepted: April 06, 2018 Published: May 11, 2018
Background and Objective: To compare the survival outcomes of patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) who received transarterial chemoembolization (TACE) before or after intensity-modulated radiotherapy (IMRT).
Methods: During the study period, the survival outcomes of HCC patients with PVTT who underwent TACE before (TACE-RT) or after IMRT (RT-TACE) were compared. Using propensity score matching (PSM), matched pairs of patients were compared.
Results: There were 76 patients in the TACE-RT group and 36 patients in the RT-TACE group. Using a 2:1 matching, 75 patients were included into this study after PSM: 50 patients in the TACE-RT group and 25 patients in the RT-TACE group. Before PSM, patients in the RT-TACE group showed significantly better survival when compared with the TACE-RT group (median survival, 13.2 months vs.7.4 months; P = 0.014) for patients with main trunk PVTT, and after PSM, the corresponding median survival was 13.2 months vs.7.4 months (P = 0.020). When compared with TACE-RT, RT-TACE had a significantly lower rate of worsening in liver function (9.5% vs. 33.3%, P = 0.044) for patients with main trunk PVTT.
Conclusions: For HCC patients with main trunk PVTT, IMRT followed by TACE yielded better survival outcomes and liver function when compared to TACE followed by IMRT.
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