Efficacy of combined modality therapy with sorafenib following hepatic arterial injection chemotherapy and three-dimensional conformal radiotherapy for advanced hepatocellular carcinoma with major vascular invasion

Takako Nomura; Joji Tani; Akihiro Deguchi; Mai Nakahara; Kyoko Oura; Tomoko Tadokoro; Koji Fujita; Shima Mimura; Teppei Sakamoto; Asahiro Morishita; Hirohito Yoneyama; Hideki Kobara; Takayuki Sanomura; Yoshihiro Nishiyama; Keiichi Okano; Yasuyuki Suzuki; Shigeo Takahashi; Toru Shibata; Kunihiko Tsutsui; Takashi Himoto; Tsutomu Masaki

doi:10.3892/mco.2019.1920

Efficacy of combined modality therapy with sorafenib following hepatic arterial injection chemotherapy and three-dimensional conformal radiotherapy for advanced hepatocellular carcinoma with major vascular invasion

Mol Clin Oncol. 2019 Nov;11(5):447-454. doi: 10.3892/mco.2019.1920. Epub 2019 Sep 9.

Authors

Takako Nomura¹, Joji Tani², Akihiro Deguchi³, Mai Nakahara¹, Kyoko Oura¹, Tomoko Tadokoro¹, Koji Fujita¹, Shima Mimura¹, Teppei Sakamoto¹, Asahiro Morishita¹, Hirohito Yoneyama¹, Hideki Kobara¹, Takayuki Sanomura⁴, Yoshihiro Nishiyama⁴, Keiichi Okano⁵, Yasuyuki Suzuki⁵, Shigeo Takahashi⁶, Toru Shibata⁶, Kunihiko Tsutsui¹, Takashi Himoto⁷, Tsutomu Masaki¹

Affiliations

¹ Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa 761-0793, Japan.
² Department of Internal Medicine, Yashima General Hospital, Takamatsu, Kagawa 761-0113, Japan.
³ Department of Internal Medicine, Kagawa Rosai Hospital, Marugame, Kagawa 763-8502, Japan.
⁴ Department of Radiology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa 761-0793, Japan.
⁵ Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa 761-0793, Japan.
⁶ Department of Radiation Oncology, Kagawa University Hospital, Kita-gun, Kagawa 761-0793, Japan.
⁷ Department of Clinical Examination, Faculty of Health Sciences, Kagawa Prefectural University of Health Sciences, Takamatsu, Kagawa 761-0123, Japan.

Abstract

The prognosis of hepatocellular carcinoma (HCC) patients exhibiting macroscopic vascular invasion (MVI) is poor, and the most appropriate treatment approach remains unclear. The current study aimed to investigate the efficacy and safety of sorafenib treatment following chemoradiotherapy for advanced HCC exhibiting MVI. A newly reported regimen, including 5-fluorouracil and cisplatin therapy (NewFP), plus three-dimensional conformal radiotherapy (3D-CRT) for MVI was used as the initial treatment. Additionally, sorafenib, as a secondary treatment, was administered after NewFP plus 3D-CRT for MVI. The present retrospective study enrolled patients with unresectable advanced HCC that was treated with NewFP plus 3D-CRT for MVI between January 2009 and December 2017. In total, 32 HCC patients with MVI were registered. Of these 32 patients, 18 were treated with NewFP plus 3D-CRT for MVI (NewFP + 3D-CRT group) and 14 were treated with sorafenib following NewFP plus 3D-CRT for MVI (sorafenib after NewFP + 3D-CRT group). The study endpoints were overall survival, overall response rate and disease control rate. Clinical factors influencing overall survival were identified using univariate and multivariate analyses. The median survival time in the NewFP + 3D-CRT group and sorafenib following NewFP + 3D-CRT group was 6.7 and 49.2 months, respectively (P=0.0003). For patients with advanced HCC exhibiting MVI, the initial treatment with NewFP plus 3D-CRT for MVI was well tolerated. The administration of sorafenib as the secondary treatment following NewFP plus 3D-CRT for MVI was associated with a significantly higher overall response rate, disease control rate and increased overall survival as compared with the NewFP plus 3D-CRT treatment.

Keywords: hepatic arterial injection chemotherapy; hepatocellular carcinoma; major vascular invasion; sorafenib; three-dimensional conformal radiotherapy.