SBRT With Immunotherapy and Atezo-Bev in HCC With Major Portal Vein Thrombosis

Inclusion Criteria

• •Patients aged ≥ 18 years old
• •ECOG performance 0 to 1
• •Confirmed diagnosis of HCC (either histologic or cytologic analysis, or clinical features according to the American Association for the Study of Liver Diseases)
• •Presence of major portal vein thrombosis (Vp3 \[first-order tumour thrombosis in portal vein\] or Vp4 \[tumour thrombosis in the main portal vein, or portal vein branch in contralateral lobe\]), limited to the liver and should be amenable to SBRT
• •No disease progression after 2 cycles of atezolizumab plus bevacizumab
• •Presence of ≤5 lesions within the liver
• •Gastric or esophageal varices must be screened; if interventions were performed, repeated upper endoscopy is needed to confirm healing of treated varices
• •Child-Pugh A liver function
• •Life expectancy longer than 3 months
• •At least one measurable treatment lesion according to RECIST 1.1
• •Extrahepatic metastases are allowed, limited to 3 sites, and not causing functional compromise
• •Written informed consent must be obtained prior to any study related procedures
• •Adequate haematological function (Hb ≥ 8.5g/dL; Plt ≥ 75x109/L; ANC ≥ 1.5x109/L; INR ≤ 1.5)
• •Adequate hepatic function (albumin ≥ 28g/L; Bilirubin ≤ 40 μmol/L; ALT \< 5 times upper limit normal)
• •Adequate renal function (serum creatinine ≤ 2 times the upper limit of normal range; Na ≥ 130mmol/L; K ≥ 3.0mmol/L)
• •Able to read, understand and provide written consent