Abstract
The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is very poor although sorafenib is recommended as the first-line treatment. Therefore, an effective treatment regime is needed for treating HCC with PVTT. This review summarized seven potential treatment regimes which including transarterial chemoembolization (TACE), TACE combined with sorafenib, TACE combined with radiotherapy (RT), hepatectomy, hepatic arterial infusion chemotherapy (HAIC), HAIC combined with sorafenib and HAIC combined with RT in the treatment of HCC with PVTT. In conclusion, hepatectomy or the combination of HAIC and sorafenib may be a more effective modality in the treatment of HCC patients with type I - II PVTT. HAIC combined with or without sorafenib/RT or the combination of RT and TACE is an alternative treatment choice for HCC patients with type III - IV PVTT. Further randomized controlled studies are warranted.
Highlights
Hepatocellular carcinoma (HCC) is one of the seven leading cancer in the world and the third leading cause of cancer related death [1]
The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is very poor sorafenib is recommended as the first-line treatment
This review summarized seven potential treatment regimes which including transarterial chemoembolization (TACE), TACE combined with sorafenib, TACE combined with radiotherapy (RT), hepatectomy, hepatic arterial infusion chemotherapy (HAIC), HAIC combined with sorafenib and HAIC combined with RT in the treatment of HCC with PVTT
Summary
Hepatocellular carcinoma (HCC) is one of the seven leading cancer in the world and the third leading cause of cancer related death [1]. The benefit of TACE for type III - IV PVTT was better than that of conservative treatment (mOS: 5.3 vs 3.4 months) [10]. Niu’s study demonstrated that the mOS of HCC patients with PVTT treated with TACE was 8.67 months, much longer than that of conservative treatment which was only 1.4 months [11]. A multicenter study showed that the mOS of patients in TACE group was 9 months and 6 months, respectively, compared with that in conservative treatment group. It showed that TACE was significantly better than conservative group for treating type I, II and III PVTT, but the benefit of TACE in type IV PVTT is not significant [12]. TACE is only a locoregional therapy and it may lead to severe liver dysfunction for type III - IV PVTT [14], so the usefulness of TACE in type III - IV PVTT is controversial
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