Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016

Table 1 Common classifications of portal vein tumor thrombosis in hepatocellular carcinoma

Group	Types of PVTT	Survival
Ikai et al[80]	Vp0: Absent	59% at 5 yr
	Vp1: Distal to but not in second-order branches	39.1% at 5 yr
	Vp2: In second-order branches	23.3% at 5 yr
	Vp3: In first-order branches	18.3% at 5 yr (Vp3 and Vp4)
	Vp4: In the main trunk or contralateral or both
Shi et al[17]	10: Microscopic
	1: In segmental branches or above	26.7% at 3 yr (Type 10 included)
	2: In the left or right branch	16.9% at 3 yr
	3: In the main trunk	3.7% at 3 yr
	4: In the superior mesenteric vein	0% at 3 yr
Xu et al[18]	A: In the main trunk or both the left and right branches	0% at 5 yr
	B: In only the left or right branch	5.2% at 5 yr

HCC: Hepatocellular carcinoma; PVTT: Portal vein tumor thrombosis.

Table 2 Prospective trials on transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombosis

Group	No. of patients	Treatments	Child-Pugh A	Survival
Luo et al[81]	164 (84 vs 80)	TACE vs Control	Not known	1-yr survival 30.9% vs 9.2%
Niu et al[82]	150 (115 vs 35)	TACE vs Control	88 vs 21	Median survival 8.67 mo vs 14 mo
Kim et al[83]	110 (49 vs 61)	TACE vs TACI	30 vs 22	Median survival 14.9 mo vs 4.4 mo
Peng et al[25]	603 (402 vs 201)	TACE vs Resection	389 vs 197	Median survival 42 mo vs 14.1 mo

TACE: Transarterial chemoembolization; PVTT: Portal vein tumor thrombosis; TACI: Transcatheter arterial chemoinfusion.

Table 3 Studies on radiation therapy for hepatocellular carcinoma with portal vein tumor thrombosis

n	Treatment	Total RT dose/fractional dose (in Gy)	Response rate (CR + PR, %)	Median survival (mo)	Toxicity grade≥3 (%)	Ref.
45	3D-CRT (+TACE/PEI/RFA; 7% RT only)	38-65/1.8-2.5	62.3 (CR 6.7)	11.2	2	Rim et al[51]
412	3D-CRT + TACE	21-60/2-5	27.9 (CR 3.6)	10.6	10	Yoon et al[44]
40	IGRT + IA 5FU/IFN vs IA 5FU/IFN	30-48/7-16	60 (CR 5)	12 (RT)	15	Chuma et al[52]
				9.1 (non-RT)
32	IA 5FU/IFN + 3D-CRT vs IA 5FU/IFN	30-45/3	75 (CR 19)	7.5 (RT)	G4: 2	Katamura et al[46]
				7.9 (non-RT)	G3: 7% (leucopenia)/6% (thrombocytopenia)/1 (anorexia)
45	PV stenting + TACE + 3D-CRT vs PV stenting + TACE	30-60/2	35.6 (CR 0)	16.5 (RT)	0	Zhang et al[45]
				4.8 (non-RT)
326	3D-CRT (IMRT 14.1%)	60/2-3	18.1 (CR 5.8)	4	0	Huang et al[53]
38	3D-CRT	17.5-50.4/1.8-4	44.7 (CR 15.8)	9.6	0	Toya et al[47]
59	3D-CRT	30-54/2-3	45.8 (CR 6.8)	7.8	0	Kim et al[48]
44	RT + TACE	36-60/2	45.5 (CR 34.1)	8	0	Kim et al[49]
19	3D-CRT (+ TACE for liver tumor)	46-60/2	57.9 (CR 0)	7	G3: 5% (thrombocytopenia)/2% (leucopenia)/2 (GI ulcers)	Yamada et al[54]
20	RT + TACE	50/2	50 (CR 0)	5.3	5	Ishikura et al[55]
24	RT + TACE	50/2	50 (CR 16.7)	CR/PR (9.7)	13%	Tazawa et al[56]
				NR/PD (3/8)
281	3D-CRT + TACE	30-54/1.8 -4.5	53.8 (CR 3.6)	11.6	20%	Yu et al[57]

3D-CRT: 3 dimensional conformal radiotherapy; GI: Gastrointestinal; PR: Partial response; RT: Radiotherapy; TACE: Transarterial chemoembolization; NR: Non-responder; PD: Progressive disease; PVTT: Portal vein tumor thrombosis.