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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2016; 22(30): 6851-6863
Published online Aug 14, 2016. doi: 10.3748/wjg.v22.i30.6851
Radiotherapy as valid modality for hepatocellular carcinoma with portal vein tumor thrombosis
Jeong Il Yu, Hee Chul Park
Jeong Il Yu, Hee Chul Park, Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
Hee Chul Park, Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06351, South Korea
Author contributions: Yu JI and Park HC analyzed the literature and wrote the manuscript; Park HC supervised the project.
Supported by Samsung Medical Center, No. GF01130081; Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, No. NRF-2015R1D1A1A01060945; Marine Biotechnology Program Funded by Ministry of Oceans and Fisheries, Korea, No. 20150220.
Conflict-of-interest statement: The authors have no conflict of interest to report.
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: Hee Chul Park, MD, PhD, Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, South Korea. hee.ro.park@samsung.com
Telephone: +82-2-34102612 Fax: +82-2-34102619
Received: March 23, 2016
Peer-review started: March 23, 2016
First decision: May 27, 2016
Revised: June 1, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: August 14, 2016
Processing time: 134 Days and 10.3 Hours
Abstract

Although the current standard treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is sorafenib, many previous studies have established the need for a reliable local modality for PVTT control, which is a major cause of liver function deterioration and metastasis. Additionally, there is growing evidence for the prognostic significance of PVTT classification according to the location of tumor thrombosis. Favorable outcomes can be obtained by applying local modalities, including surgery or transarterial chemoembolization, especially in second-order or distal branch PVTT. Rapid control of PVTT could maintain or improve liver function and reduce intrahepatic as well as distant metastasis. Radiotherapy (RT) is one of the main locoregional treatment modalities in oncologic fields, but has rarely been used in HCC because of concerns regarding hepatic toxicity. However, with the development of advanced techniques, RT has been increasingly applied in HCC management. Randomized studies have yet to definitively prove the benefit of RT, but several comparative studies have justified the application of RT in HCC. The value of RT is especially noticeable in HCC with PVTT; several prospective and retrospective studies have reported favorable outcomes, including a 40% to 60% objective response rate and median overall survival of 15 mo to 20 mo in responders. In this review, we evaluate the role of RT as an alternative local modality in HCC with PVTT.

Keywords: Hepatocellular carcinoma; Portal vein tumor thrombosis; Radiotherapy; Local modality; Alternative

Core tip: The optimal management of portal vein tumor thrombosis (PVTT), which can induce liver function deterioration and act as a source of metastasis, in patients with hepatocellular carcinoma (HCC) remains unclear. With growing evidence for the prognostic significance of PVTT classification and promising outcomes of local modalities in selected patients, the need for a reliable local modality of control is becoming increasingly apparent. In this review, the outcomes of radiotherapy as an alternative local modality for PVTT control in HCC are presented.