الفهرس 
Anatomy of the Portal VeinOnly 14 pages are availabe for public view
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Abstract
This retrospective study was carried out at the Radiation Oncology department of the University of Texas with the aim of investigating the treatment outcomes of patients with HCC who underwent proton beam therapy (PBT), focusing specifically on those with portal vein thrombosis (PVTT). The study included a total of 50 patients, 16 of whom had vascular thrombosis. The patient characteristics revealed no significant differences in demographics and general characteristics between the PVTT and non-PVTT groups, except for a higher prevalence of nonalcoholic steatohepatitis (NASH) in the PVTT group. Liver cirrhosis was observed in 32% of the patients, with HCV infection and alcohol use being the main causes.
Following radiotherapy, the majority of patients (39) did not receive any active treatment, while 11 patients underwent additional therapies. In the PVTT group, two patients received systemic therapy, and one patient underwent radiofrequency ablation (RFA). In the non-PVTT group, two patients underwent trans arterial chemoembolization (TACE), three received systemic treatment, and one patient underwent RFA, ethanol ablation, and systemic therapy.
The study analyzed tumor characteristics and found that PVTT patients had larger median tumor sizes, higher levels of alpha-fetoprotein (AFP), and a higher incidence of portal hypertension compared to the non-PVTT group. The median gross tumor volume (GTV) was also larger in the PVTT group. However, there were no significant differences in the prescribed doses of PBT, BED, and mean liver doses between the two groups. Two patients in each group received sorafenib in conjunction with radiotherapy.
Regarding treatment outcomes, the median follow-up period for all patients was 25 months. The PVTT group exhibited lower overall survival rates compared to the non-PVTT group, although the difference in overall survival between the two groups was not statistically significant. The study also found that higher radiation doses, represented by a higher BED, were associated with improved overall survival.
In terms of local control and progression-free survival, patients without PVTT had better outcomes compared to PVTT patients. Patients with higher BED achieved better median progression-free survival, and local control was better in the non-PVTT group.