Comparison of three‐dimensional conformal radiotherapy and hepatic resection in hepatocellular carcinoma with portal vein tumor thrombus

OBJECTIVE: This study aimed to evaluate the safety and efficacy of three‐dimensional conformal radiotherapy (3D‐CRT) and hepatic resection for patients with hepatocellular carcinoma (HCC) involving portal vein tumor thrombus (PVTT). METHODS: We retrospectively analyzed 323 HCC patients involving PVTT. Among them, 134 patients underwent 3D‐CRT, while 189 controls treated with hepatic resection (HR). Survival rate and prognostic analysis were performed using Kaplan‐Meier method and Cox regression analyses. RESULTS: The 1‐, 2‐, and 3‐year overall survival (OS) of RT group and HR group was 54% vs 62%, 33% vs 47%, and 18% vs 43%, respectively (P = 0.003). In the subgroup of PVTT type analysis, the 1‐, 2‐, and 3‐year OS in RT group was 65%, 39%, and 19%, respectively, while that in HR group was 83%, 53%, and 42%, respectively, in type I PVTT (P < 0.001). The 1‐, 2‐, and 3‐year OS in RT group was 52%, 35%, and 11%, while that in HR group was 55%, 42%, and 25%, respectively, in type II PVTT (P = 0.612). In type III PVTT, the 1‐, 2‐, and 3‐year OS in RT group was 16%, 3%, and 0%, respectively, while that in HR group was 11%, 0%, and 0%, respectively (P = 0.041). Multivariate analysis revealed that tumor size ≥10 cm, Child‐Pugh class B, and type III PVTT are independent predictors of poor prognosis in HCC with PVTT. CONCLUSION: 3D‐CRT appears to be an effective treatment for patients with HCC involving type II/III PVTT.