1. Safety and efficacy of TACE and gamma knife on hepatocellular carcinoma with portal vein invasion Xiao-Jie Lu, Jing Dong, Li-Juan Ji, Jin-Hong Luo, Huang-Ming Cao, Li-Xin Xiao, Jun Zhou, Chang-Quan Ling GUT 2015; August 12 F1 변종규 / prof. 김병호

3. Background Sorafenib was regarded as the standard treatment for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) Bruix et al Gut 2014;63:844–55 Sorafenib can only confer 2–3 months of overall survival (OS) benefit. Llovet et al N Engl J Med 2008;359:378–90 Inapplicable to many patients due to extensive side effects and high price. Bruix et al J Hepatol 2012;57:821 Therefore, explorations of alternative therapeutics for patients with HCC-PVTT are still needed. 3

6. Gamma knife surgery (GKS) has shown favourable effects in treating brain metastases of HCC. Park et al J Neurosurg 2014;121(Suppl):102–9 Application in the treatment of HCC-derived PVTT has not been reported It has been practiced in China for several years. Retrospectively analyse the safety and efficacy of TACE alone or in combination with GKS in treating patients with HCC-PVTT.

7. Patients with HCC with PVTT admitted to Changhai Hospital (Shanghai, China) between 1 March 2004 and 31 December 2009. Based on the treatments they received, patients were allocated into three groups: 1.Conservative group (conservative treatment only, n=108), 2.TACE group (n=203) 3.TACE followed by GKS (TG) group (n=130). Methods

8. 1. Inclusion criteria 1) Confirmed hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) who were treatment-naïve when admitted to Changhai Hospital (Shanghai, China) 2) ECOG performance status of 0-2 3) Liver function: Child-Pugh class A (score of 5 or 6) 4) Adequate hematologic (granulocyte count > 1.5×10 9 /L, platelets > 50×10 9 /L) and renal (creatinine <2.0 mg/dL) functions

9. 2. Exclusion criteria 1) Patients who received anticancer treatment such as hepatic resection, Sorafenib and radiofrequency ablation 2) Patients with hepatic vein or inferior vein invasion, extrahepatic metastases, or malignancies of other tissue-of-origin 3) Patients whose clinical/laboratory follow-ups were incomplete 4) Patients who received more than one episode of GKS

10. Gamma knife surgery (GKS) procedures: –Gamma Master Space Body Knife System which is a stereotactic body radiotherapy system –The planning target volume (PTV) was defined as a 5 mm margin around the gross tumor volume (GTV) –The median tumor margin dose was 40 Gy (ranging from 35 to 45 Gy) –Gamma knife radiotherapy was carried out in 10-12 days (five consecutive days per week)

11. RESULTS 11

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14. Treatment-related adverse events Common adverse events –Nausea, vomiting, fatigue, abdominal pain, anorexia,liver function impairment The majority of them were mild to moderate (grade 1–2), with very few (<5%) grade ≥3 ones No adverse events-induced deaths within 4 weeks post-procedure

15. Conclusion The first to investigate the safety and efficacy of TACE plus GKS on HCC with PVTT TACE and GKS may produce OS benefit in patients with HCC-PVTT TACE alone or in combination with GKS may represent alternative therapeutic options Future perspective studies are warranted to validate the results of our study