Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus

Abstract

The prognosis of patients with hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombus (PVTT) is generally poor if left untreated: a median survival time of 2.7-4.0 mo has been reported. Furthermore, while transcatheter arterial chemoembolization (TACE) has been shown to be safe in selected patients, the median survival time with this treatment is still only 3.8-9.5 mo. Systemic single-agent chemotherapy for HCC with PVTT has failed to improve the prognosis, and the response rates have been less than 20%. While regional chemotherapy with low-dose cisplatin and 5-fluorouracil or interferon and 5-fluorouracil via hepatic arterial infusion has increased the response rate, the median survival time has not exceeded 12 (range 4.5-11.8) mo. Combined treatment consisting of radiation for PVTT and TACE for liver tumor has achieved a high response rate, but the median survival rates have still been only 3.8-10.7 mo. With hepatic resection as monotherapy, the 5-year survival rate and median survival time were reportedly 4%-28.5% and 6-14 mo. The most promising results were reported for combined treatments consisting of hepatectomy and TACE, chemotherapy, or internal radiation. The reported 5-year survival rates and median survival times were 42% and 31 mo for TACE followed by hepatectomy; 36.3% and 22.1 mo for hepatectomy followed by hepatic arterial infusion chemotherapy; and 56% for chemotherapy or internal radiation followed by hepatectomy.

Sorafenib therapy following resection prolongs disease-free survival in patients with advanced hepatocellular carcinoma at a high risk of recurrence

“…The prognosis for patients with HCC complicated by PVTT is extremely poor, with a median survival of only 2-4 months (13)(14)(15)(16)(17) for those receiving surgical resection, portal vein stent, transcatheter arterial chemoembolization (TACE), radiotherapy, 125 I seed implantation, percutaneous ethanol injection (PEI) or laser ablation (18).…”

Pathological Complete Remission of Advanced Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombosis by Hepatic Arterial Infusion Chemotherapy

“…The tumor response with HAIC has been reported to be superior to TACE or supportive care. 10 Therefore, HAIC might be a reasonable approach to the treatment of patients with advanced HCC. Although HAIC using low-dose 5-FU and cisplatin has been reported to be a useful treatment regimen, rationales for low-dose 5-FU were not described clearly in the previous studies.…”

Single bolus regional chemotherapy with doxorubicin versus chemoembolization in a rabbit vx2 tumor model

“…However, little has been reported on the usefulness of the combined use of these two routes compared to the use of TACE alone. Transarterial treatments cannot be used to eradicate tumor cells in portal tracts or the peripheral and extracapsular portions of advanced HCCs that derive their blood supplies from portal veins (7,(10)(11)(12). We hypothesized that the transportal delivery of chemotherapy could address these limitations of transarterial therapy.…”