Published online Jun 18, 2015. doi: 10.4254/wjh.v7.i11.1553
Peer-review started: September 23, 2014
First decision: November 27, 2014
Revised: March 16, 2015
Accepted: April 10, 2015
Article in press: April 14, 2015
Published online: June 18, 2015
Processing time: 265 Days and 19.9 Hours
Patients with hepatocellular carcinoma (HCC) accompanying portal vein tumor thrombosis (PVTT) have relatively few therapeutic options and an extremely poor prognosis. These patients are classified into barcelona clinic liver cancer stage C and sorafenib is suggested as the standard therapy of care. However, overall survival (OS) gain from sorafenib is unsatisfactory and better treatment modalities are urgently required. Therefore, we critically appraised recent data for the various treatment strategies for patients with HCC accompanying PVTT. In suitable patients, even surgical resection can be considered a potentially curative strategy. Transarterial chemoembolization (TACE) can be performed effectively and safely in a carefully chosen population of patients with reserved liver function and sufficient collateral blood flow nearby the blocked portal vein. A recent meta-analysis demonstrated that TACE achieved a substantial improvement of OS in HCC patients accompanying PVTT compared with best supportive care. In addition, transarterial radioembolization (TARE) using yttrium-90 microspheres achieves quality-of-life advantages and is as effective as TACE. A large proportion of HCC patients accompanying PVTT are considered to be proper for TARE. Moreover, TACE or TARE achieved comparable outcomes to sorafenib in recent studies and it was also reported that the combination of radiotherapy with TACE achieved a survival gain compared to sorafenib in HCC patients accompanying PVTT. Surgical resection-based multimodal treatments, transarterial approaches including TACE and TARE, and TACE-based appropriate combination strategies may improve OS of HCC patients accompanying PVTT.
Core tip: Given the modest survival gain and the limitation of sorafenib, such as resistance and tolerability, there are still clinical unmet needs in the management of patients with hepatocellular carcinoma (HCC) accompanying portal vein tumor thrombosis (PVTT). Surgical resection-based multimodal treatments including liver transplantation and transarterial chemoembolization-based appropriate combination strategies for resectable HCC accompanying PVTT may improve overall survival in these patients.