Published online Jan 7, 2016. doi: 10.3748/wjg.v22.i1.407
Peer-review started: June 27, 2015
First decision: September 11, 2015
Revised: October 15, 2015
Accepted: November 24, 2015
Article in press: November 24, 2015
Published online: January 7, 2016
The natural history of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal (approximately 2-4 mo), and PVTT is reportedly found in 10%-40% of HCC patients at diagnosis. According to the Barcelona Clinic Liver Cancer (BCLC) Staging System (which is the most widely adopted HCC management guideline), sorafenib is the standard of care for advanced HCC (i.e., BCLC stage C) and the presence of PVTT is included in this category. However, sorafenib treatment only marginally prolongs patient survival and, notably, its therapeutic efficacy is reduced in patients with PVTT. In this context, there have been diverse efforts to develop alternatives to current standard systemic chemotherapies or combination treatment options. To date, many studies on transarterial chemoembolization, 3-dimensional conformal radiotherapy, hepatic arterial chemotherapy, and transarterial radioembolization report better overall survival than sorafenib therapy alone, but their outcomes need to be verified in future prospective, randomized controlled studies in order to be incorporated into current treatment guidelines. Additionally, combination strategies have been applied to treat HCC patients with PVTT, with the hope that the possible synergistic actions among different treatment modalities would provide promising results. This narrative review describes the current status of the management options for HCC with PVTT, with a focus on overall survival.
Core tip: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is associated with a grave prognosis if left untreated. Sorafenib is the only treatment modality recommended for treating HCC patients with PVTT according to most international HCC treatment guidelines. However, the survival benefits observed following systemic sorafenib treatment are only marginal. Under these circumstances, the need for better treatment options remains unfulfilled. In this comprehensive review, various treatment options are presented-including transarterial chemoembolization, transarterial radioembolization, hepatic arterial infusion, chemotherapy, and radiotherapy-and their outcomes, along with combination strategies.