Treatment for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: The Emerging Role for Radioembolization Using Yttrium-90Lau W.-Y. · Sangro B. · Chen P.-J. · Cheng S.-Q. · Chow P. · Lee R.-C. · Leung T. · Han K.-H. · Poon R.T.P.
aFaculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China; bLiver Unit, Clínica Universitaria de Navarra and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Pamplona, Spain; cHepatitis Research and Department of Internal Medicine, National Taiwan University and Hospital, Taipei, Taiwan, ROC; dEastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China; eDepartment of General Surgery, Singapore General Hospital, and fOffice of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore; gDepartment of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; hComprehensive Oncology Centre, Hong Kong Sanatorium and Hospital Hong Kong, Hong Kong, SAR, China; iDepartment of Internal Medicine, Yonsei Liver Cancer Special Clinic, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea; jDepartment of Surgery, The University of Hong Kong, Hong Kong, SAR, China
Background/Purpose: Patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) have an extremely poor prognosis and relatively few treatment options. Method: During a consensus meeting, experts met to examine the published data for HCC treatment strategies in patients with PVTT. Results: Many treatment guidelines consider the presence of PVTT a contraindication to partial hepatectomy or liver transplantation. Transarterial chemoembolization (TACE) is associated with an increased risk of ischemic necrosis of liver and of treatment-related death in patients with PVTT, and is, therefore, limited to a select group of patients with good hepatic function and adequate collateral circulation around the occluded portal vein. Systemic sorafenib results in survival benefit in patients regardless of the presence of PVTT. However, side effects are common, and there are no effects on time-to-symptom progression or quality of life. Transarterial radioembolization (TARE) with yttrium-90 microspheres is emerging as a valuable strategy. A wider range of patients with PVTT are suitable for this procedure compared to TACE. TARE is as effective as TACE in HCC and has quality-of-life advantages. Conclusion: In patients with HCC with PVTT, medical evidence suggests that TARE is a good choice of treatment.