The Progress in the Treatment of Hepatocellular Carcinoma With Portal Vein Tumor Thrombus

Abstract

Hepatocellular carcinoma (HCC) is one of most prevalent cancer and is a serious healthcare issue worldwide. Portal vein tumor thrombus (PVTT) is a frequent complication and remains as the blockage in the treatment of HCC with high recurrence rate and poor prognosis. There is still no global consensus or standard guideline on the management of HCC with PVTT. In western countries, Sorafenib and Lenvatinib are recommended as the first-line treatment options for HCC patients with PVTT where this condition is now regarded as BCLC Stage C regardless of PVTT types. However, there is growing evidence that supports the close relationship of the extent of PVTT to the prognosis of HCC. Besides the targeted therapy, more aggressive treatment modalities have been proposed and practiced in the clinic which may improve the prognosis of HCC patients with PVTT and prolong the patients’ survival time, such as transarterial chemoembolization, radiotherapy, hepatic resection, liver transplantation, and various combination therapies. Herein, we aim to review and summarize the advances in the treatment of HCC with PVTT.

Safety and Efficacy of Liver-Directed Radiotherapy in Combination With Lenvatinib for Hepatocelluar Carcinoma With Macroscopic Tumor Thrombosis

“…Macroscopic tumor thrombosis in HCC is one of the most serious conditions associated with poor prognosis, representing the Barcelona Clinic Liver Cancer stage C ( 5 ). This condition is generally considered an indication for systemic agents rather than local therapies because of its association with rapid intrahepatic and extrahepatic metastases, as well as concerns about maintaining liver function ( 21 ). In certain patients with this condition, favorable long-term outcomes through surgical resection, including tumor thrombus, have been reported ( 10 , 22 ).…”

A Novel Microcrystalline BAY-876 Formulation Achieves Long-Acting Antitumor Activity Against Aerobic Glycolysis and Proliferation of Hepatocellular Carcinoma

“…For now, molecularly targeted drugs are still the main treatment strategy for advanced HCC (72)(73)(74). Among them, Sorafenib is the most widely used (75)(76)(77). In order to overcome the shortcomings of Sorafenib, newly molecular targeted drugs including Regorafenib, Lenvatinib and Cabozantinib have been approved for marketing one after another (78)(79)(80).…”

Advances in the surgical treatment of liver cancer

“…However, the benefit was not significant in patients whose PVTT affected the main trunk or contralateral branch (Vp4). A similar study in a Chinese population reported that as long as the PVTT was confined to the first-order branch of the portal vein, the patient may be eligible for resection (41). Resection most commonly precedes hepatic dissection.…”