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Table of Contents
Vol. 84, No. 5, 2013
Issue release date: May 2013
Oncology 2013;84:311-318

Treatment for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: The Emerging Role for Radioembolization Using Yttrium-90

Lau 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

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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.

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  1. Yang JD, Roberts LR: Hepatocellular carcinoma: a global view. Nat Rev Gastroenterol Hepatol 2010;7:448-458.
  2. Bruix J, Sherman M: AASLD practice guideline: management of hepatocellular carcinoma: an update (July 2010). (accessed 2012).
  3. Ferenci P, Fried M, Labrecque D, et al: World Gastroenterology Organization Guideline. Hepatocellular carcinoma (HCC): a global perspective. J Gastrointestin Liver Dis 2010;19:311-317.

    External Resources

  4. Pirisi M, Avellini C, Fabris C, et al: Portal vein thrombosis in hepatocellular carcinoma: age and sex distribution in an autopsy study. J Cancer Res Clin Oncol 1998;12:397-400.

    External Resources

  5. Cheung TK, Lai CL, Wong BCY, Fung J, Yuen MF: Clinical features, biochemical parameters, and virological profiles of patients with hepatocellular carcinoma in Hong Kong. Aliment Pharmacol Ther 2006;24:573-583.
  6. Minagawa M, Makuuchi M: Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus. World J Gastroenterol 2006;12:7561-7567.
  7. Llovet JM, Bustamante J, Castells A, et al: Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 1999;29:62-67.
  8. Schöniger-Hekele M, Müller C, Kutilek M, Oesterreicher C, Ferenci P, Gangl A: Hepatocellular carcinoma in Central Europe: prognostic features and survival. Gut 2001;48:103-109.
  9. Lau WY, Lai Ee, Yu SC: Management of portal vein tumor thrombus; in Lau WY (ed): Hepatocellular Carcinoma. Singapore, World Scientific Publishing, 2008, pp 739-760.
  10. Omata M, Lesmana LA, Tateishi R, et al: Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010;4:439-474.
  11. Jelic S, Sotiropoulos GC, ESMO Guidelines Working Group: Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010;21(suppl 5):v59-v64.
  12. Lau WY, Lai EC: Hepatocellular carcinoma: current management and recent advances. Hepatobiliary Pancreat Dis Int 2008;7:237-257.
  13. Chen XP, Qiu FZ, Wu ZD, et al: Effects of location and extension of portal vein tumor thrombus on long-term outcomes of surgical treatment for hepatocellular carcinoma. Ann Surg Oncol 2006;13:940-946.
  14. Shi J, Lai EC, Li N, et al: Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus. Ann Surg Oncol 2010;17:2073-2080.
  15. Lin DX, Zhang QY, Li X, Ye QW, Lin F, Li LL: An aggressive approach leads to improved survival in hepatocellular carcinoma patients with portal vein tumor thrombus. J Cancer Res Clin Oncol 2011;137:139-149.
  16. Wu CC, Hsieh SR, Chen JT, et al: An appraisal of liver and portal vein resection for hepatocellular carcinoma with tumor thrombi extending to portal bifurcation. Arch Surg 2000;135:1273-1279.
  17. Llovet JM, Ricci S, Mazzaferro V, et al: Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008;359:378-390.
  18. Cheng AL, Kang YK, Chen Z, et al: Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomization, double-blind placebo-controlled trial. Lancet Oncol 2009;10:25-34.
  19. Connock M, Round J, Bayliss S, Tubeuf S, Greenheld W, Moore D: Sorafenib for the treatment of advanced hepatocellular carcinoma. Health Technol Assess 2010;14(suppl 1):17-21.

    External Resources

  20. Hawkins MA, Dawson LA: Radiation therapy for hepatocellular carcinoma: from palliation to cure. Cancer 2006;106:1653-1663.
  21. Lin CS, Jen YM, Chiu SY, et al: Treatment of portal vein tumor thrombosis of hepatoma patients with either stereotactic radiotherapy or three-dimensional conformal radiotherapy. Jpn J Clin Oncol 2006;36:212-217.
  22. Shirai S, Sato M, Suwa K, et al: Single photon emission computed tomography-based three-dimensional conformal radiotherapy for hepatocellular carcinoma with portal vein tumor thrombus. Int J Radiat Oncol Biol Phys 2009;73:824-831.
  23. Toya R, Murakami R, Baba Y, et al: Conformal radiation therapy for portal vein tumor thrombosis of hepatocellular carcinoma. Radiother Oncol 2007;84:266-271.
  24. Zeng ZC, Fan J, Tang ZY, et al: A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus. Int J Radiat Oncol Biol Phys 2005;61:432-443.
  25. Llovet JM, Real MI, Montaña X, et al: Arterial embolization or chemoembolization versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359:1734-1739.
  26. Lo CM, Ngan H, Tso WK, et al: Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002;35:1164-1171.
  27. Llovet JM, Bruix J: Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003;37:429-442.
  28. Luo J, Guo RP, Lai EC, et al: Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study. Ann Surg Oncol 2011;18:413-420.
  29. Chung GE, Lee JH, Kim HY, et al: Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology 2011;258:627-634.
  30. Liapi E, Geschwind JF: Intra-arterial therapies for hepatocellular carcinoma: where do we stand? Ann Surg Oncol 2010;17:1234-1246.
  31. Kennedy A, Nag S, Salem R, et al: Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the Radioembolization Brachytherapy Oncology Consortium (REBOC). Int J Radiat Oncol Biol Phys 2007;68:13-23.
  32. Sato K, Lewandowski RJ, Bui JT, et al: Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere): assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol 2006;29:522-529.
  33. Goin JE, Dancey JE, Roberts CA, Sickles CJ, Leung DA, Soulen MC: Comparison of post-embolization syndrome in the treatment of patients with unresectable hepatocellular carcinoma: trans-catheter arterial chemoembolization versus yttrium-90 glass microspheres. World J Nucl Med 2004;3:49-56.
  34. Salem R, Thurston KG: Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. 1. Technical and methodologic considerations. J Vasc Interv Radiol 2006;17:1251-1278.
  35. Sangro B, Salem R, Kennedy A, Coldwell D, Wasan H: Radioembolization for hepatocellular carcinoma: a review of the evidence and treatment recommendations. Am J Clin Oncol 2011;34:422-431.
  36. Salem R, Lewandowski RJ, Mulcahy MF, et al: Radioembolization for hepatocellular carcinoma using yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology 2010;138:52-64.
  37. Salem R, Thurston KG: Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. 2. Special topics. J Vasc Interv Radiol 2006;17:1425-1439.
  38. Riaz A, Lewandowski RJ, Kulik LM, et al: Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol 2009;20:1121-1130.
  39. Wang SC, Bester L, Burnes JP, et al: Clinical care and technical recommendations for 90yttrium microsphere treatment of liver cancer. J Med Imaging Radiat Oncol 2010;54:178-187.
  40. Lau W-Y, Kennedy AS, Kim Y-H, et al: Patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres. Int J Radiat Oncol Biol Phys 2012;82:401-407.
  41. Lewandowski RJ, Kulik LM, Riaz A, et al: A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant 2009;9:1920-1928.
  42. Kooby DA, Egnatashvili V, Srinivasan S, et al: Comparison of yttrium-90 radioembolization and transcatheter arterial chemoembolization for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol 2010;21:224-230.
  43. Carr BI, Kondragunta V, Buch SC, Branch RA. Therapeutic equivalence in survival for hepatic arterial chemoembolization and yttrium 90 microsphere treatments in unresectable hepatocellular carcinoma: a two-cohort study. Cancer 2010;116:1305-1314.
  44. Salem R, Lewandowski RJ, Kulik L, et al: Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 2011;140:497-507.
  45. Hilgard P, Hamami M, Fouly AE, et al: Radioembolization with yttrium-90 glass microspheres in hepatocellular carcinoma: European experience on safety and long-term survival. Hepatology 2010;52:1741-1749.
  46. Sangro B, Carpanese L, Cianni R, et al: Survival after 90Y resin microsphere radioembolization of hepatocellular carcinoma across BCLC stages: a European evaluation. Hepatology 2011;54:868-878.
  47. Iñarrairaegui M, Thurston KG, Bilbao JI, et al: Radioembolization with use of yttrium-90 resin microspheres in patients with hepatocellular carcinoma and portal vein thrombosis. J Vasc Interv Radiol 2010;21:1205-1212.
  48. Tsai AL, Burke CT, Kennedy AS, et al: Use of yttrium-90 microspheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis. J Vasc Interv Radiol 2010;21:1377-1384.
  49. Woodall CE, Scoggins CR, Ellis SF, et al: Is selective internal radioembolization safe and effective for patients with inoperable hepatocellular carcinoma and venous thrombosis? J Am Coll Surg 2009;208:375-382.
  50. Kulik LM, Carr BI, Mulcahy MF, et al: Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 2008;47:71-81.
  51. Memon K, Kulik L, Lewandowski RJ, et al: Radioembolization for hepatocellular carcinoma with portal vein thrombosis: impact of liver function on systemic treatment options at disease progression. J Hepatol 2013;58:73-80.

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