Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3462
Peer-review started: November 25, 2014
First decision: December 11, 2014
Revised: December 24, 2014
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: March 28, 2015
Management of hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) is complex and requires an understanding of multiple therapeutic options. PVT is present in 10%-40% of HCC at the time of diagnosis, and is an adverse prognostic factor. Management options are limited, as transplantation is generally contraindicated, and surgical resection is only rarely performed in select centers. Systemic medical therapy with sorafenib has been shown to modestly prolong survival. Transarterial chemoembolization has been performed in select cases but has shown a high incidence of complications. Emerging data on treatment of PVT with Y-90 radioembolization suggest that this modality is well-tolerated and associated with favorable overall survival. Current society guidelines do not yet specifically recommend radioembolization for patients with PVT, but this may change with the development of newer staging systems and treatment algorithms. In this comprehensive literature review, we present current and available management options with the relative advantages, disadvantages and contraindications of these treatment options with summarized data on overall survival.
Core tip: Management for hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) is more challenging and limited than for HCC without PVT. Currently, liver transplantation is generally contraindicated and surgical resection with curative intent is controversial. Systemic chemotherapy with sorafenib has been shown to modestly prolong survival. Transarterial chemoembolization has traditionally been considered to be contraindicated due to its high embolic effect causing hepatic necrosis and worsening liver dysfunction. External radiation therapy is limited by the sensitivity of the liver to radiation toxicity. In this review, these treatment options are comprehensively presented, along with a relatively new modality in the treatment of HCC, selective internal radiation therapy with yttrium-90.