{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T06:00:25Z","timestamp":1785218425280,"version":"3.55.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The study aimed to evaluate the efficacy and safety of intensity-modulated radiotherapy (IMRT) combined with immunotherapy and targeted therapy (IT) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) classification I\u2013IV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>\n                      The study analyzed HCC patients with PVTT who received IMRT combined with immunotherapy and targeted therapy (RT+IT,\n                      <jats:italic>n<\/jats:italic>\n                      = 176) or immunotherapy and targeted therapy alone (IT,\n                      <jats:italic>n<\/jats:italic>\n                      = 136). Propensity score matching (PSM) was performed to reduce baseline imbalance. Comparisons were made between the two groups in overall survival (OS), progression-free survival (PFS), and treatment-related adverse events. Subgroup analyses were further conducted to evaluate OS and PFS across PVTT classification I\u2013IV. Cox regression analysis was performed to identify independent prognostic factors in patients receiving RT+IT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Following PSM, 97 pairs of participants were matched. In RT+IT, the median OS was longer (27.63 months, 95% CI: 20.00\u201333.00) compared to IT (17.57 months, 95% CI: 15.20\u201322.10), with a hazard ratio (HR) of 0.467 (95% CI:\u00a00.323\u20130.675,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). The cumulative OS rates at 3, 6, 12, 24, and 36 months were 99.0%, 96.9%, 83.3%, 54.2%, and 27.6% for RT+IT vs. 99.0%, 91.6%, 76.8%, 27.1%, and 12.2% for IT (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). RT+IT had a longer median PFS (12.30 months,95% CI: 10.47\u201316.45) than IT (7.20 months, 95% CI: 6.37\u20139.67) (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Subgroup analysis by PVTT classification revealed that RT+IT was associated with improved OS and PFS across PVTT I, II, III, and IV than IT. Grade 3\u20134 adverse events between the two groups had no significant statistical difference. Biologically effective dose (BED10,\n                      <jats:italic>\u03b1<\/jats:italic>\n                      \/\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a010 Gy), alpha fetoprotein (AFP), Child\u2013Pugh (CP) grade, Cheng\u2019s classification of PVTT, and combined transcatheter chemoembolization (TACE) were identified as independent predictors of OS in patients who underwent RT+IT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IMRT combined with immunotherapy and targeted therapy was associated with improved survival outcomes with a manageable safety profile in HCC patients with PVTT across classification I\u2013IV.<\/jats:p>\n                  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