Real-world outcomes of stereotactic body radiotherapy plus sintilimab and bevacizumab for hepatocellular carcinoma with portal vein tumor thrombus

BACKGROUND: Sintilimab plus bevacizumab (Sin + Bev) is recommended as a first-line treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT); however, its efficacy remains limited. This study aimed to assess the efficacy and safety of stereotactic body radiotherapy (SBRT) combined with Sin + Bev for HCC with PVTT. PATIENTS AND METHODS: This retrospective study included 69 HCC patients with PVTT treated at two centers in China from August 2021 to December 2022. Patients received either SBRT + Sin + Bev (n = 31) or Sin + Bev alone (n = 38). Primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary endpoints included objective response rate (ORR) and treatment-related adverse events (TRAEs). RESULTS: Baseline characteristics showed similar distributions between the two groups. SBRT + Sin + Bev group showed a significant increase in both median OS (18.9 vs 9.3 months, P < .001), median PFS (9.1 vs 4.7 months, P = .0015), and ORR (64.6% vs 26.3%, P = .031) compared to Sin + Bev group. TRAEs in SBRT + Sin + Bev group were mostly manageable and acceptable compared to Sin + Bev group. Multivariate analysis confirmed that SBRT + Sin + Bev was an independent prognostic factor for better OS (P < .001) and better PFS (P < .001). CONCLUSION: SBRT combined with sintilimab plus bevacizumab appears to improve treatment efficacy and demonstrates a favorable safety and feasibility profile for HCC with PVTT.