J Liver Cancer Search


J Liver Cancer > Volume 16(2); 2016 > Article
Journal of Liver Cancer 2016;16(2):69-81.
DOI: https://doi.org/10.17998/jlc.16.2.69    Published online September 30, 2016.
Locoregional Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis
Sang Youn Hwang1, Ryoung-Go Kim2, Cheol-Won Choi3, Sang Bu Ahn4
1Departments of Internal Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
2Hepatobiliary and Pancreatic Surgery,Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
3Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
4Radiology and Radiologic Science, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
Correspondence:  Sang Youn Hwang,
Email: mongmani@hanmail.net
Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) have a extremely poor prognosis. According to the Barcelona Clinic Liver Cancer guideline, sorafenib is a standard therapy in this situation, but many clinicians still select locoregional therapy (LRT) such as transarterial therapy, external beam radiation therapy (EBRT), even surgical resection (SR) or combination of LRTs because the survival improvement by sorafenib is unsatisfactory. Based on recent meta-analysis and prospective study, transarterial chemoembolization (TACE) and transarterial radioembolization seem to be effective and safe therapeutic option that have comparable outcome to sorafenib. Recently large nationwide studies demonstrated that SR can be a potentially curative treatment in selected patients. Hepatic arterial infusion chemotherapy (HAIC) can be also good option, especially in Child class B patients based on small volume prospective studies. Moreover, multidisciplinary strategies based on the combination of LRTs (SR plus TACE, TACE + EBRT, TACE + Sorafenib, HAIC + EBRT etc.) may improve survival of HCC patients with PVTT. Finally we discuss individualized and tailored treatment strategies for different clinical situations.
Key Words: Hepatocellular carcinoma; Portal vein tumor thrombosis; Locoregional treatment; Sorafenib

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