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

Abstract

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.

The dosimetric importance of the number of 90Y microspheres in liver transarterial radioembolization (TARE)

“…vascular invasion/extrahepatic spread) [3,4]. Many studies below the highest level of evidence in which patients with intermediate and advanced HCC were treated with 90 Y microspheres have already suggested the outcomes following TARE compare favourably with those following conventional treatments [5][6][7][8][9][10].…”

Prognostic Significance of18F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study

“…With only about 30% of patients able to undergo curative treatments, most HCC patients are referred for noncurative treatments (1,3). For intermediate-to-advanced-stage HCC patients without extrahepatic metastasis, transarterial chemoembolization (TACE) is the first-line treatment (1,4,5); however, diverse treatment modalities have been used to improve the treatment response and prognosis (6,7). Local radiotherapy has been effective in controlling HCC progression (8), and concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) has recently been considered as an attractive alternative treatment strategy for locally advanced HCC (9-11).…”

Treatment of Hepatocellular Cancer Due to Hepatitis Delta with Yttrium-90 Radioembolization in a Patient with Cirrhosis: A Case Report

“…With the Y90 TaRe method, the disease is controlled at a rate more than 80% and it is generally well tolerated. It's major complication is PvT, however, this is not due to its microembolic effect but its radiation effect on untargeted tissues including the liver (18,19,20,21). no PvT was detected in our patient.…”