CT-guided high-dose-rate brachytherapy ablation of HCC patients with portal vein tumor thrombosis

Abstract Background We assessed the safety and efficacy of computed tomography (CT)-guided high-dose-rate (HDR) brachytherapy in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Methods From January 2010 to January 2022, 56 patients (median age 67.5 years) with HCC and PVTT underwent 64 procedures. PVTT was further classified according to the Japan liver cancer study group into VP1–VP4. Tumor response was evaluated by cross-sectional imaging 6 weeks after CT-guided HDR brachytherapy and every 3 months thereafter. Local tumor control (LTC), progression-free survival (PFS), and overall survival (OS) were assessed using Kaplan–Meier curves. The severity of procedure-related complications was classified according to the Society of Interventional Radiology guidelines. Results Patients were available for imaging evaluation for a median follow-up of 14.0 months. The median diameter of the largest lesion was 56 mm. Estimated median PFS, LTC, and OS were 7.0 (95% CI 5.0–13.0), 14.0 (95% CI 7.0–21.0), and 20.0 (95% CI 13.0–26.0) months respectively. Actuarial 1-, 2-, and 3-year OS rates were 66%, 41%, and 27%, respectively. Subclassified for VP1, VP2, VP3, and VP4 estimated OS was 38.0 (95% CI 9.0-Not-a-number), 21.5 (95% CI 15.0–25.0), 15.0 (95% CI 7.0–33.0), and 13.0 (95% CI 6.0–34.0) months, respectively. Considering the 64 procedures, we recorded no complications for 49 (76.6%), mild-to-moderate complications for 12 (18.8%), and major complications for 3 (4.7%). Conclusion CT-guided HDR brachytherapy was safe and effective for locoregional treatment in patients with advanced HCC due to PVTT, achieving long-lasting local tumor control. Relevance statement CT-guided HDR brachytherapy is an option to be considered for locoregional treatment of patients with advanced HCC due to PVTT. Key Points Evaluation of CT-guided high-dose-rate (HDR) brachytherapy in treating HCC patients with portal vein tumor thrombosis (PVTT). Median OS was 20.0 months ranging between 13.0 and 38.0 months. CT-guided HDR brachytherapy seems to be a safe and effective treatment option in HCC patients with PVTT. Graphical Abstract