Effective treatment strategies other than sorafenib for the patients with advanced hepatocellular carcinoma invading portal vein

Table 2 Comparing various treatment strategies for hepatocellular carcinoma patients accompanying portal vein tumor thrombosis

	Indication	Advantages	Disadvantages
Sorafenib	BCLC stage C	Showing survival benefit	Modest efficacy compared to placebo control
		in infiltrative type HCC	Hand-foot skin reaction
TACE	Nodular type HCC up to Vp4	Wide indication	Post TACE syndrome
	Child A liver function		Potential risk of liver failure
TARE	Tumor extension ≤ 50% of liver volume	Down-staging allowing	Requiring additional lung shunt study
	Unilobar	liver transplantation	due to the risk of lung injury
	Nodular type
	Up to Vp4
RFA	Single medium-sized HCCs (3-5 cm)	Less invasive	If the intraparenchymal tumor was not completely ablated by RFA, complete effects on the thrombus probably would not be produced
Surgery	Up to Vp4	Less expensive technic	Invasive and expensive technic
	Single medium-sized HCCs ( ≤ 7 cm)	Better outcomes than other patients	Potential risk of liver failure
	Up to Vp4	with HCC who are BCLC stage C
	No HV/IVC invasion	with Child A liver function
External beam	AFP ≤ 30 ng/mL	Combined to multimodal strategies	Potential risk of radiation induced liver disease
radiotherapy	Tumor extension ≤ 60% of liver volume		Potential risk of GI tract toxicities

BCLC: Barcelona clinic liver cancer; HCC: Hepatocellular carcinoma; TACE: Transarterial chemoembolization; TARE: Transarterial radioembolization; RFA: Radiofrequency ablation; HV: Hepatic vein; IVC: Inferior vena cava; AFP: Alpha-fetoprotein; GI: Gastrointestinal.