Ultrasonic guided radiotherapy for hepatocellular carcinoma with portal vein invasion

Portal vein invasion (PVI) is frequently seen in hepatocellular carcinoma (HCC). Transcatheter arterial embolization (TAE) helped in part of patients. External irradiation was scheduled concomitantly with TACE in 23 HCC patients. The irradiation was performed under real-time ultrasound (US) localization through anterior, right 45 degree or right horizontal directions. The irradiation was given as daily dose of 200 cGy, 5 days a week and a total dose of at least 3000 cGy. The results were followed by US at second week, 4th week, 8th week, and than every 3 months. One patient showed stationary diseases. Sixteen PVI shrinked. Six showed complete disappearance of PVI. Six of 23 patients had recurrence during follow up period. Ultrasound guidance could provide an adequate field for irradiation that resulted in excellent effect and smallest liver injury.