The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus

Int J Surg. 2015 Aug:20:8-16. doi: 10.1016/j.ijsu.2015.05.009. Epub 2015 May 27.

Abstract

Purpose: To further improve the effectiveness and prognosis of primary hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT), the current status of treatment for HCC with PVTT was reviewed.

Methods: A Medline search was undertaken to identify articles using the keywords "HCC", "PVTT" and "therapy". Additional papers were identified by a manual search of the references from the key articles.

Results: PVTT, as a common complication of HCC, was divided into type I ∼ IV. The therapeutic approach is mainly composed of five types: surgical resection, regional interventional therapy, radiotherapy, combination therapy, targeted therapy. All of these therapeutic approaches were separately evaluated in detail.

Conclusions: For those resectable tumors, the better choice for treatment of HCC with PVTT should be hepatectomy and removal of PVTT. For those unresectable tumors, TACE (especially the super-selective TACE) has been the preferred palliative treatment, the other regional interventional therapy and/or radiotherapy could improve the therapeutic effects. The multidisciplinary treatments may further improve the quality of life and prolong the survival period for the HCC patients associated with PVTT.

Keywords: Hepatocellular carcinoma (HCC); Portal vein tumor thrombus (PVTT); Therapeutic strategy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Carcinoma, Hepatocellular / therapy*
  • Catheter Ablation
  • Chemoembolization, Therapeutic*
  • Combined Modality Therapy
  • Hepatectomy* / methods
  • High-Intensity Focused Ultrasound Ablation
  • Humans
  • Liver Neoplasms / therapy*
  • Male
  • Middle Aged
  • Neoplastic Cells, Circulating*
  • Portal Vein* / pathology
  • Prognosis
  • Quality of Life
  • Radiotherapy, Conformal*
  • Thrombosis / surgery*
  • Treatment Outcome