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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3462-3471
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3462
Management of hepatocellular carcinoma with portal vein thrombosis
Matthew Quirk, Yun Hwan Kim, Sammy Saab, Edward Wolfgang Lee
Matthew Quirk, Edward Wolfgang Lee, Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-743730, United States
Yun Hwan Kim, Department of Radiology, Korea University College of Medicine, Seoul 120-750, South Korea
Sammy Saab, Department of Medicine, Division of Hepatology, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA 90095-743730, United States
Author contributions: Quirk M, Kim YH, Saab S and Lee EW equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Edward Wolfgang Lee, MD, PhD, Department of Radiology, Division of Interventional Radiology, Ronald Reagan Medical Center at UCLA, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095-743730, United States. edwardlee@mednet.ucla.edu
Telephone: +1-310-2678771
Received: November 24, 2014
Peer-review started: November 25, 2014
First decision: December 11, 2014
Revised: December 24, 2014
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: March 28, 2015
Processing time: 126 Days and 0.1 Hours
Abstract

Management of hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) is complex and requires an understanding of multiple therapeutic options. PVT is present in 10%-40% of HCC at the time of diagnosis, and is an adverse prognostic factor. Management options are limited, as transplantation is generally contraindicated, and surgical resection is only rarely performed in select centers. Systemic medical therapy with sorafenib has been shown to modestly prolong survival. Transarterial chemoembolization has been performed in select cases but has shown a high incidence of complications. Emerging data on treatment of PVT with Y-90 radioembolization suggest that this modality is well-tolerated and associated with favorable overall survival. Current society guidelines do not yet specifically recommend radioembolization for patients with PVT, but this may change with the development of newer staging systems and treatment algorithms. In this comprehensive literature review, we present current and available management options with the relative advantages, disadvantages and contraindications of these treatment options with summarized data on overall survival.

Keywords: Hepatocellular carcinoma; Portal vein thrombosis; Yttrium 90; Selective internal radiation therapy; Management

Core tip: Management for hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) is more challenging and limited than for HCC without PVT. Currently, liver transplantation is generally contraindicated and surgical resection with curative intent is controversial. Systemic chemotherapy with sorafenib has been shown to modestly prolong survival. Transarterial chemoembolization has traditionally been considered to be contraindicated due to its high embolic effect causing hepatic necrosis and worsening liver dysfunction. External radiation therapy is limited by the sensitivity of the liver to radiation toxicity. In this review, these treatment options are comprehensively presented, along with a relatively new modality in the treatment of HCC, selective internal radiation therapy with yttrium-90.