Objective To evaluate the effectiveness and prognosis of patients in advanced hepatocellular carcinoma (HCC) with portal vein (PV) tumor thrombus received external-beam radiation therapy (EBRT). Methods The clinical data of 126 HCC patients with PV tumor thrombus who were referred for EBRT at our institution from January 2000 to November 2009 were analyzed retrospectively. EBRT was designed to focus on the tumor thrombus with or without primary intrahepatic tumors， to deliver a median total conventional dose of 50 Gy (range of 30-60 Gy). Predictors of survival were identified using univariate and multivariate analysis. Results Unfavorable pretreatment predictors were associated by multivariate analysis with lower albumin and higher α-fetoprotein levels, poorer Child-Pugh liver function classification, poorer intrahepatic tumor control， lymph node metastases， and the two-dimensional EBRT technique. The dose of EBRT showed no significant in both univariate and multivariate survival analysis. Conclusions In patients with HCC， EBRT is effectively prevents progression in cases of PV tumor thrombus， but palliative dose of EBRT is not related to survival.EBRT is not related to survival.
ObjectiveTo evaluate the safety and technical feasibility of salvage liver transplantation (SLT) after liver resection, and its influence on prognosis. MethodsThe clinical data of 289 patients who underwent liver transplantation by cadaveric grafts treating for hepatocellular carcinoma met the UCSF criteria from June 2001 to December 2008 were analyzed retrospectively. Among them, 242 patients underwent primary liver transplantation (PLT, PLT group), and 47 patients underwent SLT for recurrence (SLT group). Perioperative factors and survival were compared between two groups. ResultsThere were no significant differences of age, gender, and pathology of tumor between two groups (Pgt;0.05). The operation time in the SLT group was significantly longer than that in the PLT group 〔(7.1±1.8) h versus (6.4±1.4) h， P=0.004〕. The differences of intraoperative blood loss 〔(2 560.5±2 683.6) ml versus (2 042.9±2 006.2) ml， P=0.173〕 and blood transfusion 〔(13.8±12.9) U versus (9.9±12.6) U， P=0.087〕 were not significant between two groups. The mean interval time from resection to transplantation was (32.8±32.4) months. The median followup was 38.7 months, 3year overall and diseasefree survivals were not significantly different (82.3% versus 75.5%, P=0.312; 78.8% versus 70.1%, P=0.755, respectively) between the SLT group and PLT group. According to intentiontotreat analysis, the 3year overall survival in the SLT group was significantly longer than that in the PLT group (88.4% versus 76.2%, P=0.047). ConclusionsIn selected patients, liver resection prior to transplantation neither increases operative morbidity nor impairs prognosis following liver transplantation. SLT after liver resection, can be an alterative treatment for HCC.