title: Treatment for hepatocellular carcinoma with portal vein tumor thrombosis: the emerging role for radioembolization using yttrium-90.
abstract: OBJECTIVE
  Patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) have an extremely poor prognosis and relatively few treatment options.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  In patients with HCC with PVTT, medical evidence suggests that TARE is a good choice of treatment.
authors.affiliation: Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China. josephlau@surgery.cuhk.edu.hk
authors.forename: Wan-Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
authors.forename: Pier-Jer
authors.initials: PJ
authors.lastname: Chen
authors.forename: Shu-Qun
authors.initials: SQ
authors.lastname: Cheng
authors.forename: Pierce
authors.initials: P
authors.lastname: Chow
authors.forename: Rheun-Chuan
authors.initials: RC
authors.lastname: Lee
authors.forename: Thomas
authors.initials: T
authors.lastname: Leung
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Ronnie T P
authors.initials: RT
authors.lastname: Poon
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018450:Disease Progression; D006801:Humans; D007511:Ischemia / Q000473:pathology; D008113:Liver Neoplasms / Q000628:therapy*; D009336:Necrosis / Q000473:pathology; D011169:Portal Vein / Q000473:pathology*; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes