title: 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.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Department of Artificial Organ and Transplantation, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan. minagawa-tky@umin.ac.jp
authors.forename: Masami
authors.initials: M
authors.lastname: Minagawa
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery / Q000628:therapy*; D011169:Portal Vein; D020246:Venous Thrombosis / Q000209:etiology / Q000628:therapy*