Abstract
PurposeThis study aims to evaluate to efficacy, feasibility, and safety of the tumor tracking magnetic resonance imaging (MRI)-guided hypofractionated radiotherapy (HFRT) and stereotactic body radiation therapy (SBRT) for portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) patients.MethodsWe retrospectively reviewed the twelve cases of unresectable HCC with tumor thrombus in the main trunk or first branch of the portal vein that were treated with tumor tracking MRI-guided HFRT or SBRT using the ViewRay Linac MRIdian system between June 2019 and January 2021. The HFRT was performed with a total of 50 Gy in 10 fractions, and SBRT performed in a range of 36-50 Gy with 4-5 fractions. The median biologic effective dose (BED) with an a/b ratio of 10 was 75 Gy10 (range, 68.4–100 Gy10). ResultsThe median follow-up duration was 5.0 months (range, 1.7–12.8 months). Ten patients (83.3%) showed an objective response of PVTT. At the time of analysis, 10 patients (83.3%) showed local control. The median survival of these patients was 11.6 months (range, 1.9–12.8 months). Three patients (25%) showed mild gastrointestinal symptoms, and there were no cases of grade 3 or higher toxicity. For hepatic toxicity, there were no cases of Child-Puch score increased by more than 2 points after RT without disease progression. ConclusionTumor tracking MRI-guided HFRT and SBRT was a feasible, effective, and safe treatment option in HCC patients with tumor thrombi in the main trunk or first branch of the portal vein.