Editorial
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 21, 2006; 12(47): 7561-7567
Published online Dec 21, 2006. doi: 10.3748/wjg.v12.i47.7561
Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus
Masami Minagawa, Masatoshi Makuuchi
Masami Minagawa, Masatoshi Makuuchi, Department of Hepato-Biliary-Pancreatic Surgery, Department of Artificial Organ and Transplantation, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Masami Minagawa, MD, PhD, Department of Hepato-Biliary-Pancreatic Surgery, Department of Artificial Organ and Transplantation, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. minagawa-tky@umin.ac.jp
Telephone: +81-3-38155411 Fax: +81-3-56843989
Received: July 15, 2006
Revised: August 1, 2006
Accepted: August 6, 2006
Published online: December 21, 2006
Abstract

The prognosis of patients with hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombus (PVTT) is generally poor if left untreated: a median survival time of 2.7-4.0 mo has been reported. Furthermore, while transcatheter arterial chemoembolization (TACE) has been shown to be safe in selected patients, the median survival time with this treatment is still only 3.8-9.5 mo. Systemic single-agent chemotherapy for HCC with PVTT has failed to improve the prognosis, and the response rates have been less than 20%. While regional chemotherapy with low-dose cisplatin and 5-fluorouracil or interferon and 5-fluorouracil via hepatic arterial infusion has increased the response rate, the median survival time has not exceeded 12 (range 4.5-11.8) mo. Combined treatment consisting of radiation for PVTT and TACE for liver tumor has achieved a high response rate, but the median survival rates have still been only 3.8-10.7 mo. With hepatic resection as monotherapy, the 5-year survival rate and median survival time were reportedly 4%-28.5% and 6-14 mo. The most promising results were reported for combined treatments consisting of hepatectomy and TACE, chemotherapy, or internal radiation. The reported 5-year survival rates and median survival times were 42% and 31 mo for TACE followed by hepatectomy; 36.3% and 22.1 mo for hepatectomy followed by hepatic arterial infusion chemotherapy; and 56% for chemotherapy or internal radiation followed by hepatectomy.

Keywords: Hepatocellular carcinoma; Portal vein tumor Thrombus; Hepatic resection; Transcatheter arterial chemoembolization; Chemotherapy; Radiation