title: Treatment of hepatocellular carcinoma with portal venous tumor thrombosis: A comprehensive review.
abstract: The natural history of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal (approximately 2-4 mo), and PVTT is reportedly found in 10%-40% of HCC patients at diagnosis. According to the Barcelona Clinic Liver Cancer (BCLC) Staging System (which is the most widely adopted HCC management guideline), sorafenib is the standard of care for advanced HCC (i.e., BCLC stage C) and the presence of PVTT is included in this category. However, sorafenib treatment only marginally prolongs patient survival and, notably, its therapeutic efficacy is reduced in patients with PVTT. In this context, there have been diverse efforts to develop alternatives to current standard systemic chemotherapies or combination treatment options. To date, many studies on transarterial chemoembolization, 3-dimensional conformal radiotherapy, hepatic arterial chemotherapy, and transarterial radioembolization report better overall survival than sorafenib therapy alone, but their outcomes need to be verified in future prospective, randomized controlled studies in order to be incorporated into current treatment guidelines. Additionally, combination strategies have been applied to treat HCC patients with PVTT, with the hope that the possible synergistic actions among different treatment modalities would provide promising results. This narrative review describes the current status of the management options for HCC with PVTT, with a focus on overall survival.
authors.affiliation: Kichang Han, Jin Hyoung Kim, Gi-Young Ko, Dong Il Gwon, Kyu-Bo Sung, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 388-1, South Korea.
authors.forename: Kichang
authors.initials: K
authors.lastname: Han
authors.affiliation: Kichang Han, Jin Hyoung Kim, Gi-Young Ko, Dong Il Gwon, Kyu-Bo Sung, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 388-1, South Korea.
authors.forename: Jin Hyoung
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Kichang Han, Jin Hyoung Kim, Gi-Young Ko, Dong Il Gwon, Kyu-Bo Sung, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 388-1, South Korea.
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.affiliation: Kichang Han, Jin Hyoung Kim, Gi-Young Ko, Dong Il Gwon, Kyu-Bo Sung, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 388-1, South Korea.
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Gwon
authors.affiliation: Kichang Han, Jin Hyoung Kim, Gi-Young Ko, Dong Il Gwon, Kyu-Bo Sung, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 388-1, South Korea.
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
mesh_terms: D000072198:ADAM17 Protein / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000628:therapy*; D009536:Niacinamide / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D011169:Portal Vein; D020266:Radiotherapy, Conformal; D000077157:Sorafenib; D020246:Venous Thrombosis / Q000209:etiology* / Q000628:therapy*
chemical_list: D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib; D000072198:ADAM17 Protein
keywords: Hepatic arterial chemotherapy; Hepatocellular carcinoma; Portal vein tumor thrombosis; Radiotherapy; Sorafenib; Transarterial chemoembolization; Transarterial radioembolization