Abstract
Background/AimsLimited treatment options are available for patients with hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT). Transarterial radioembolization using Yttrium-90 microspheres is a new treatment modality for HCC with PVT. For this analysis, we compared responses to treatment with radioembolization and with sorafenib.MethodsWe evaluated 32 patients who were part of a multicenter retrospective cohort. All patients had PVT without extrahepatic metastasis and were treated with radioembolization in one of six tertiary referral hospitals in Korea. We retrospectively enrolled another 31 consecutive PVT patients without extrahepatic metastasis from a single center who received sorafenib treatment to serve as the control group. We used inverse probability weighting (IPW) using propensity scores to adjust for the between-group differences in baseline characteristics.ResultsAt 3 months, the response rate and disease control rate were 32.1% (9/32) and 57.1% (16/32), respectively, in the radioembolization group and 3.2% (1/31) and 41.9% (13/31) in the sorafenib group. Median overall survival (OS) and time to progression (TTP) were not significantly different between the radioembolization group and the sorafenib group (13.8 months and 10.0 months, P = 0.22; and 6.0 months and 6.0 months, P = 0.08; respectively). No differences in OS (P = 0.97) or TTP (P = 0.34) were observed after IPW was applied to balance the population characteristics. The sorafenib group showed significantly more grade 3/4 adverse effects than the radioembolization group (P < 0.01).ConclusionHCC patients with PVT who underwent radioembolization achieved comparable survival to patients who received sorafenib, even after application of IPW. The radioembolization group also experienced fewer severe adverse effects. Radioembolization can be considered a new treatment option for patients with HCC with PVT.
Highlights
In 2008, hepatocellular carcinoma (HCC) was the sixth most common cancer and the third most frequent cause of death worldwide [1]
No differences in overall survival (OS) (P = 0.97) or time to progression (TTP) (P = 0.34) were observed after inverse probability weighting (IPW) was applied to PLOS ONE | DOI:10.1371/journal.pone
Patients with vascular invasion account for a large proportion of HCC cases; these patients are classified as having advanced stage HCC, according to the Barcelona Clinic Liver Cancer (BCLC) staging system
Summary
In 2008, hepatocellular carcinoma (HCC) was the sixth most common cancer and the third most frequent cause of death worldwide [1]. Portal vein thrombosis (PVT) is the main cause of vascular invasion in HCC patients and negatively affects prognosis [2] Definitive treatment such as liver transplantation (LT) is contraindicated in HCC patients with PVT because patients with PVT have high recurrence rates and low cure rates. Neither the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trial [8] nor the Asia-Pacific trial [9] reported any cases of complete remission (CR) and reported only minor partial remission (PR) after treatment with sorafenib. Those trials provide evidence to support sorafenib use for HCC patients with PVT, but the low response rates are unsatisfactory for most clinicians
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
