Stereotactic body radiation therapy in patients with unresectable hepatocellular carcinoma and portal vein tumor thrombosis

doi:10.4254/wjh.v17.i12.110993

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Hepatol. Dec 27, 2025; 17(12): 110993
Published online Dec 27, 2025. doi: 10.4254/wjh.v17.i12.110993

Stereotactic body radiation therapy in patients with unresectable hepatocellular carcinoma and portal vein tumor thrombosis

Divya Khosla, Venkata Krishna Vamsi Gade, Rakesh Kapoor, Gaganpreet Singh, Ranjit Singh, Sunil Taneja, Madhumita Premkumar, Naveen Kalra, Arka De, Harish Bhujade, Nipun Verma, Ajay Duseja, Rajesh Gupta

Divya Khosla, Venkata Krishna Vamsi Gade, Rakesh Kapoor, Gaganpreet Singh, Ranjit Singh, Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India

Sunil Taneja, Madhumita Premkumar, Arka De, Nipun Verma, Ajay Duseja, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India

Naveen Kalra, Harish Bhujade, Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India

Rajesh Gupta, Department of Gastrointestinal Surgery, Hepatopancreatobiliary, and Liver Transplantation, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India

Co-first authors: Divya Khosla and Venkata Krishna Vamsi Gade.

Co-corresponding authors: Divya Khosla and Rakesh Kapoor.

Author contributions: Khosla D and Kapoor R contributed equally to the study and are co-corresponding authors. Khosla D and Gade VKV contributed equally to this manuscript and are co-first authors. Khosla D, Gade VKV, Kapoor R, Taneja S, Premkumar M, De A, Verma N, Duseja A, Kalra N, and Bhujade H contributed to follow-up of the patients; Khosla D and Gade VKV contributed to manuscript preparation statistical analysis; Khosla D, Kapoor R, and Gupta R contributed editing; Khosla D, Kapoor R, Singh G, and Singh R contributed to treatment; Khosla D contributed to conceptualization, study concepts and design, experimental studies, data analysis, and was guarantor of integrity of the study; Kapoor R contributed to supervision; Singh G and Singh R contributed to radiation planning and quality assurance; Gupta R, Taneja S, Premkumar M, De A, Verma N, Duseja A contributed to patient selection; Taneja S, Premkumar M, De A, Verma N, Duseja A contributed to medical management; Kalra N and Bhujade H performed radiology for diagnosis. All the authors have reviewed the manuscript for its content and approved the final version before submission.

Institutional review board statement: This study was approved by the Institutional Ethics Committee (No. IEC-INT/2025/Study-2980). On behalf of all co-authors, I confirm that the study was conducted in accordance with ethical principles and that patient confidentiality has been strictly upheld.

Informed consent statement: Our study is a retrospective analysis of de-identified patient data collected from existing medical records. No personally identifiable information has been disclosed or published at any stage of the study. In accordance with our institutional guidelines and ethical standards, the requirement for written informed consent was waived.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The data supporting the study will be available upon request after institutional approvals.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Divya Khosla, MD, Additional Professor, Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Room No. 54, Radiotherapy and Oncology Office, Ground Floor, Nehru Hospital Extension, Chandigarh 160012, India. dr_divya_khosla@yahoo.com

Received: June 23, 2025
Revised: July 22, 2025
Accepted: November 11, 2025
Published online: December 27, 2025
Processing time: 189 Days and 3.6 Hours

Abstract

BACKGROUND

About 35%-50% of patients with hepatocellular cancer (HCC) present with portal venous tumor thrombosis (PVTT). Stereotactic body radiation therapy (SBRT) offers a promising approach for locoregional treatment in patients with HCC with PVTT. This study aimed to report the clinical characteristics and early outcomes of patients with unresectable HCC and PVTT treated with SBRT.

AIM

To report the clinical characteristics and early outcomes of patients with unresectable HCC and PVTT treated with SBRT.

METHODS

This retrospective, single-institution study included adult HCC patients with PVTT treated between March 2020 and December 2023. Eligibility criteria included Child-Pugh A-B liver function, serum bilirubin < 3 mg/dL, Eastern Co-operative Oncology Group performance status 0-2, a normal liver volume > 700 cc, and a tumor-lumen distance > 5 mm. SBRT dose and fractionation were determined based on tumor volume and organ-at-risk constraints. Baseline clinical and dosimetric parameters were recorded. Survival analysis was performed using Kaplan-Meier curves, response was assessed at 3 months post-SBRT using the Revised Response Evaluation Criteria in Solid Tumors 1.1 criteria, and toxicity was graded per Common Terminology Criteria for Adverse Events 4.0.

RESULTS

Thirty patients (median age: 65 years, 90% male) were included. Sixteen (53.3%) were Child-Pugh A, and fourteen (46.6%) were Child-Pugh B. Sixty percent had VP4 disease. SBRT doses ranged from 30-50 Gy in 5-6 fractions. The median tumor diameter was 6.1 cm, and the median follow-up was 15 months. The overall response rate was 83.3%, with a median overall survival of 13 months and progression-free survival of 10.2 months. No grade 4 toxicities were observed.

CONCLUSION

SBRT has the potential to be an effective modality for locoregional control in patients with unresectable HCC with PVTT.

Keywords: Hepatocellular carcinoma; Portal venous tumor thrombosis; Stereotactic body radiation therapy; Kaplan-Meier curves; Barcelona clinic liver cancer

Core Tip: Portal vein tumor thrombosis is a common and challenging presentation in hepatocellular carcinoma, significantly limiting treatment options. This retrospective study highlights the safety and efficacy of stereotactic body radiation therapy as a locoregional treatment in patients with unresectable hepatocellular carcinoma and portal vein tumor thrombosis. With an encouraging response rate of 83.3% and a median overall survival of 13 months, stereotactic body radiation therapy demonstrates promising early outcomes and minimal toxicity, supporting its role as a viable therapeutic option in this difficult-to-treat population.