Efficacy of radiation plus transarterial chemoembolization and lenvatinib in hepatocellular carcinoma with portal vein tumor thrombus

Aoran Dong; Meiyan Zhu; Zeyu Zhang; Wenzhe Fan; Zhiqiang Wu; Yong Chen; Jianfei Tu; Yaojun Zhang; Wenquan Zhuang; Xiaofang He; Zhenwei Peng

doi:10.3389/fonc.2023.1320818

Efficacy of radiation plus transarterial chemoembolization and lenvatinib in hepatocellular carcinoma with portal vein tumor thrombus

Front Oncol. 2023 Dec 19:13:1320818. doi: 10.3389/fonc.2023.1320818. eCollection 2023.

Authors

Aoran Dong^#¹, Meiyan Zhu^#¹, Zeyu Zhang^#¹, Wenzhe Fan², Zhiqiang Wu³, Yong Chen¹, Jianfei Tu⁴, Yaojun Zhang⁵, Wenquan Zhuang³, Xiaofang He¹, Zhenwei Peng^{1

6}

Affiliations

¹ Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
³ Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁴ Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, China.
⁵ Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
⁶ Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

^# Contributed equally.

Abstract

Background: We aimed to investigate the efficacy of a novel regimen, external beam radiation (RT) combined with trans arterial chemoembolization (TACE) and lenvatinib (LEN), in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus.

Methods: We prospectively observed 102 participants from three tertiary medical centers in China between October 2018 and October 2020, who chose either RT plus TACE and LEN (RT-TACE-LEN) or TACE and LEN (TACE-LEN). LEN (12 mg or 8 mg daily) was administrated orally and continued until progression or intolerable side effects were noted. TACE was given one day after administration of LEN, and RT began within 4 weeks after the first TACE. The median dose/fraction of RT was 50 Gy/25 fractions (range: 45-60 Gy/25 fractions). Overall survival and progression free survival were compared between two groups, and complications were assessed.

Results: Both 51 patients received RT-TACE-LEN and TACE-LEN, respectively. Most patients had tumor size> 5 cm (73.8%) and tumor number≥ 2 (69.9%). The overall incidence of toxicities was significantly higher in RT-TACE-LEN group than TACE-LEN group (100% vs. 64.7%, p< 0.001), but incidences of grade 3-4 toxicities were comparable (54.9% vs. 49.0%, p= 0.552). Both median overall survival (22.8 vs. 17.1 months, p= 0.031) and median progression-free survival (12.8 vs. 10.5 months, p= 0.035) were significantly longer after RT-TACE-LEN treatment than TACE-LEN.

Conclusions: The addition of RT to TACE and LEN was safe, and might improve clinical outcomes of patients with advanced HCC, which needs conformation from further studies.

Keywords: TACE; external beam radiation; hepatocellular carcinoma; lenvatinib; portal vein tumor thrombus.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Natural Science Foundation of China (No. 82072029 and No. 82303738), the National high level talents special support plan - “Ten thousand plan” - Young top - notch talent support program, and the Guangdong Basic and Applied Basic Research Foundation (No. 2021A1515111101).