Safety and Efficacy of Radiation Plus TACE and Lenvatinib in Advanced HCC With PVTT

Inclusion Criteria: 1. age 18-75 years; 2. histologically or cytologically or clinically confirmed diagnosis of HCC; 3. presenting with PVTT and at least one measurable intrahepatic lesion on the basis of modified Response Evaluation Criteria in Solid Tumors (mRECIST); an intrahepatic lesion consisting of a single tumor (≤ 10.0 cm) or multiple tumors (≤ 3 foci) with the tumor burden \< 50%; 4. Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1; 5. Child-Pugh class A or B; 6. life expectancy of at least 3 months; 7. satisfactory blood, liver, and kidney function parameters. The acceptable blood, liver, and kidney parameters were (1) neutrophil count ≥ 1.5 × 109/L; (2) platelet count ≥ 60 × 109/L; (3) hemoglobin concentration ≥ 90 g/L; (4) serum albumin concentration ≥ 30 g/L; (5) bilirubin ≤ 50 μmol/L; (6) AST and ALT \< 5 × upper limit of normal (ULN) and alkaline phosphatase \< 4 × ULN; (7) extended prothrombin time \< 6 seconds of ULN; and (8) serum creatinine \< 1.5 × ULN. Exclusion Criteria: 1. history of liver and adjacent tissue radiation; 2. medical history of hepatic decompensation, such as hepatic encephalopathy and esophageal or gastric variceal bleeding; 3. extrahepatic spread; 4. combination with other malignant diseases; 5. contraindications for TACE; 6. pregnant and lactating women; 7. severe dysfunction of the heart, kidney, or other organs; 8. hypersensitivity to intravenous contrast agents; 9. with HIV, syphilis infection; 10. allogeneic organ transplant recipients; 11. suffering from mental and psychological diseases may affect informed consent; 12. unable to take oral medication; 13. active gastric or duodenal ulcers within 3 months before enrollment.