Transarterial chemoembolization in hepatocellular carcinoma with portal vein tumor thrombosis: a systematic review and meta-analysis

Silva, Jack P.; Berger, Nicholas G.; Tsai, Susan; Christians, Kathleen K.; Clarke, Callisia N.; Mogal, Harveshp; White, Sarah B.; Rilling, William S.; Gamblin, T. Clark

doi:10.1016/j.hpb.2017.04.016

Cited by 99 publications

(90 citation statements)

References 29 publications

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“…313 Impaired portal vein blood flow (for example, a portal vein thrombus, hepatofugal blood flow) is considered an absolute contraindication for TACE, although it can be performed safely in patients with segmental or sub-segmental portal vein obstruction if the treatment is selective. 525 However, TACE is not recommended in patients with segmental portal vein tumour invasion. Such indications should be discussed in multidisciplinary team sessions, in light of TARE and alternative first and second-line systemic treatments.…”

Section: Patient Selectionmentioning

confidence: 99%

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

Galle¹,

Forner²,

Llovet³

et al. 2018

Journal of Hepatology

6,918

4,351

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Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Hepatocellular carcinoma represents about 90% of primary liver cancers and constitutes a major global health problem. The following Clinical Practice Guidelines will give up-to-date advice for the clinical management of patients with hepatocellular carcinoma, as well as providing an in-depth review of all the relevant data leading to the conclusions herein.

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Section: Patient Selectionmentioning

confidence: 99%

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

Galle¹,

Forner²,

Llovet³

et al. 2018

Journal of Hepatology

6,918

4,351

View full text Add to dashboard Cite

show abstract

“…In a meta-analysis of PVTT patients treated with TACE, 1% experienced liver failure and 18% had posttreatment complications. 44 Due to the potential risk of hepatic failure following ischemic liver injury, TACE is traditionally contraindicated in patients with PVTT involving the main portal trunk or the first-order branches. 45 In recent years, an increasing number of studies have explored the role of TACE in the management of patients with PVTT.…”

Section: Transarterial Chemoembolizationmentioning

confidence: 99%

“…Meta-analysis among PVTT patients receiving TACE showed that TACE was associated with a survival benefit for patients with branch portal vein involvement compared with those with main portal vein involvement. 44 Although there are multiple staging systems for PVTT, these were largely developed for hepatic resection evaluation. Assessment of liver function with Child-Pugh classification appears to prognosticate for patients with unresectable HCC treated with TACE.…”

Section: Transarterial Chemoembolizationmentioning

confidence: 99%

Hepatocellular Carcinoma with Portal Vein Tumor Involvement: Best Management Strategies

2018

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Portal vein tumor thrombosis (PVTT) commonly occurs in patients with hepatocellular carcinoma (HCC). Patients with PVTT usually have an aggressive disease course, decreased liver function reserve, limited treatment options, higher recurrence rates after treatment, and, therefore, worse overall survival. Among untreated HCC patients with PVTT, the median overall survival has been reported as low as 2 to 4 months. Historically, many aspects of PVTT have impacted the theoretical and practical safety and efficacy of treatment, for example, disordered blood flow and associated impairment of liver function, heat-sink effects of blood flow in the area of the PVTT, and risk of recurrence due to tumor location in the blood vessel. The current Barcelona Clinic Liver Cancer staging system categorizes HCC patients with PVTT as advanced stage, for which the standard of care is targeted therapy with sorafenib. However, sorafenib is associated with only marginal benefits among patients with PVTT. First-line lenvatinib, which was shown to be noninferior to sorafenib, excluded patients with main portal trunk invasion. Regorafenib and nivolumab, an immune-based therapy, were recently approved in the United States for second-line therapy after sorafenib. Preliminary results for cabozantinib suggest a benefit in the second-/third-line after sorafenib failure. In addition, rapid advances in many fields (surgery, interventional radiology, nuclear medicine, and immunotherapy) have increased the potential treatment options for the management of this complex disease entity. A large portion of the emerging evidence focuses on the broader category of advanced HCC of which PVTT is a subgroup. While many of these studies show promising results, the efficacy among PVTT patients requires validation in prospective studies. Real-world data may help fill the evidence gap for patients not eligible for clinical trials due to common hepatic function requirements. The variety of new treatment advances for the heterogeneous and complex disease entity of HCC with PVTT means that personalized, multidisciplinary management may be necessary to achieve optimal outcomes. In this narrative review, we summarize the evolving management strategies for patients with HCC and PVTT.

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“…75 A systematic review and meta-analysis examined the efficacy of cTACE stratified by main (main portal vein [MPV]) and branch (portal vein branch [PVB]) portal vein invasion. 76 A total of 1,333 patients received an estimated median of two (range: 2-4) TACE sessions. Response rates, defined by complete or partial response according to the mRECIST criteria, were similar: 14% (9-20%) and 16% (8-26%) (p ¼ 0.238).…”

Section: Advanced Stage (C)mentioning

confidence: 99%

Embolotherapy for Hepatic Oncology: Current Perspectives and Future Directions

Bajwa

Madoff

Kishore

2020

Digestive Disease Interventions

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Primary and secondary liver cancers are a major cause of mortality worldwide. Transarterial liver-directed therapy, or embolotherapy, represents an important locoregional treatment strategy for primary and secondary liver tumors. Embolotherapeutic modalities include bland embolization (transarterial embolization), chemoembolization (transarterial chemoembolization), and radioembolization or selective internal radiotherapy. A brief technical overview of embolotherapeutic modalities as well as supportive evidence for the treatment of most common primary and secondary liver tumors will be discussed in this review. Several potential future applications, including synergy with systemic therapy, interventional theranostics, and artificial intelligence will also be reviewed briefly.

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Transarterial chemoembolization in hepatocellular carcinoma with portal vein tumor thrombosis: a systematic review and meta-analysis

Abstract: TACE is a safe treatment for a highly selected population of HCC patients with PVT. Despite worse survival rates compared to PVB thrombosis, PVT in the MPV should not be considered an absolute contraindication to TACE.

Cited by 99 publications

References 29 publications

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

Hepatocellular Carcinoma with Portal Vein Tumor Involvement: Best Management Strategies

Embolotherapy for Hepatic Oncology: Current Perspectives and Future Directions

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