Surgical Resection is Preferred in Selected Solitary Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

2022 ◽  
Author(s):  
Jaehun Yang ◽  
Jong Man Kim ◽  
Jinsoo Rhu ◽  
Gyu-Seong Choi ◽  
Choon Hyuck David Kwon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Initial Treatment ◽  
Survival Curve ◽  
Primary Treatment ◽  
Portal Vein Tumor Thrombosis ◽  
Patient Death ◽  
Tumor Thrombosis ◽  
Surgery Group ◽  
Treatment Naïve

Backgrounds: Sorafenib is the standard care for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT), though it offers limited survival. This study was designed to compare clinical outcomes between liver resection (surgery) and trans-arterial chemoembolization plus radiotherapy (TACE-RT) as the initial treatment modality for resectable treatment-naïve solitary HCC combined with subsegmental (Vp1), segmental (Vp2), and lobar (Vp3) PVTT. Methods: From the institutional HCC registry, we identified 116 patients diagnosed with resectable treatment-naïve HCC with Vp1-Vp3 PVTT based on radiologic images who received surgery (n=44) or TACE-RT (n=72) as a primary treatment between 2010 and 2015. A propensity score matching (PSM) model was created. Results: The TACE-RT group had a higher tumor burden (tumor size, extent, and markers) than the surgery group. Cumulative patient survival curve in the surgery group was significantly higher than in the TACE-RT group before and after PSM. Liver function was relatively well-preserved in the surgery group compared with the TACE-RT group. TACE-RT group, male, increased alkaline phosphatase, and increased platelet count were predisposing factors for patient death in resectable treatment-naïve solitary HCC with PVTT. Conclusions: The present study suggests that surgery should be considered as an initial treatment in resectable treatment-naïve solitary HCC with Vp1-Vp3 PVTT.

scholarly journals Transarterial chemoembolization for hepatocellular carcinoma combined with portal vein tumor thrombosis

2018 ◽  
Vol Volume 10 ◽  
pp. 4719-4726 ◽  
Author(s):  
Wei-Fu Lv ◽  
Kai-Cai Liu ◽  
Dong Lu ◽  
Chun-Ze Zhou ◽  
De-Lei Cheng ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Transarterial Chemoembolization ◽  
Portal Vein Tumor Thrombosis ◽  
Tumor Thrombosis

Predictive factors of benefit from iodine-125 brachytherapy for hepatocellular carcinoma with portal vein tumor thrombosis

Brachytherapy ◽  
2019 ◽  
Vol 18 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Junqing Lin ◽  
Han Jiang ◽  
Weizhu Yang ◽  
Na Jiang ◽  
Qubin Zheng ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Predictive Factors ◽  
Portal Vein Tumor Thrombosis ◽  
Tumor Thrombosis ◽  
Iodine 125

scholarly journals Observation of Stereotactic Radiosurgery (Cyberknife) on Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

2018 ◽  
Vol 2 (4) ◽  
Author(s):  
Yang Tang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Survival Rate ◽  
Portal Vein ◽  
Stereotactic Radiosurgery ◽  
Cox Proportional Hazards Model ◽  
Cumulative Survival Rate ◽  
Portal Vein Tumor Thrombosis ◽  
Cumulative Survival ◽  
Tumor Thrombosis ◽  
Stable Conditions

The purpose of the study was to analyze the clinical effect of stereotactic radiosurgery (SRS) (Cyberknife) on hepatocellular carcinoma with portal vein tumor thrombosis (HCC-PVTT). Data from 50 patients with HCC-PVTT who received Cyberknife from August 2013 to April 2016 was collected for efficacy analysis. Moreover, survival correlation was evaluated by Cox proportionalhazards model. The total effective rate in 1–3 months after treatment was 64.00%, including 7 cases in complete remission, 12 cases in partial remission, 13 cases in stable conditions, and 18 cases with enlargement; a 4–24-months follow-up (with an average of 11.58 ± 2.58 months) showed that median survival, 1-year cumulative survival rate, and 2-year cumulative survival rate were, respectively, 11.86 ± 1.79 months, 48.00%, and 20.00%. Moreover, the Cox proportional-hazards model indicates that it was with no correlation between lesion diameter, classification of liver function, pre-operative alphafetoprotein, types of hepatitis, number of tumors, ascites, types of tumor emboli, total dose, and survival rate. SRS is effective for HCC-PVTT and serves as an ideal treatment clinically to help preserve patients’ lives, which is worthy of clinical promotion and application.

Liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis

2021 ◽  
Vol 21 (2) ◽  
pp. 105-112
Author(s):  
Sang Jin Kim ◽  
Jong Man Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Radiation Therapy ◽  
Portal Vein ◽  
Alpha Fetoprotein ◽  
Advanced Hepatocellular Carcinoma ◽  
Portal Vein Tumor Thrombosis ◽  
Donor Liver Transplantation ◽  
Tumor Thrombosis ◽  
Locoregional Therapies

Traditionally, liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis is not recommended. However, with recent developments in locoregional therapies for hepatocellular carcinoma, more aggressive treatments have been attempted for advanced hepatocellular carcinoma. Recently, various studies on locoregional therapies for downstaging followed by living donor liver transplantation reported inspiring overall survival and recurrence-free survival of patients. These downstaging procedures included three-dimensional conformal radiation therapy, trans-arterial chemoembolization, stereotactic body radiation therapy, trans-arterial radioembolization, hepatic arterial infusion chemotherapy and combinations of these therapies. Selection of the optimal downstaging protocol should depend on tumor location, biology and background liver status. The risk factors affecting outcome include pre-downstaging alpha-fetoprotein values, delta alpha-fetoprotein values, disappearance of portal vein tumor thrombosis on imaging and meeting the Milan criteria or not after downstaging. For hepatocellular carcinoma with portal vein tumor thrombosis, downstaging procedure with liver transplantation in mind would be helpful. If the reaction of the downstaged tumor is good, liver transplantation may be performed.

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