Management Strategies for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus
Summary
Hepatocellular carcinoma complicated by portal vein tumour thrombus (PVTT) represents an advanced stage of liver malignancy with a historically poor prognosis. Management demands a multidisciplinary approach tailored to tumour burden, thrombus extent and underlying liver function. Surgical resection remains an option for carefully selected patients, particularly those with limited PVTT and preserved hepatic reserve. Neoadjuvant regional therapies such as hepatic arterial infusion chemotherapy (HAIC) may downstage thrombus and improve post-operative survival. Locoregional modalities, including transarterial procedures and advanced radiotherapy techniques, offer local control and potential conversion to curative treatment. Systemic agents, notably multikinase inhibitors and combination immunotherapies, have extended survival in unresectable cases and are increasingly integrated with local treatments. Current strategies emphasise personalised sequencing and combination of surgery, regional therapy and systemic treatment to prolong overall survival, maintain quality of life and expand curative opportunities.
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Management Strategies for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus publication trend
The graph below shows the total number of articles in management strategies for hepatocellular carcinoma with portal vein tumor thrombus across all publications each year (not limited to Nature Index journals).
Technical terms
Hepatocellular carcinoma (HCC): The most common primary cancer of the liver, originating from hepatocytes.
Portal vein tumour thrombus (PVTT): Extension of malignant cells into the portal venous system, signifying vascular invasion and advanced disease.
Hepatic arterial infusion chemotherapy (HAIC): Administration of chemotherapeutic agents directly into the hepatic artery to concentrate therapy within the liver and associated thrombus.
Intensity-modulated radiotherapy (IMRT): A precision external-beam radiation technique that shapes dose distribution to maximise tumour irradiation while sparing normal tissue.
References
- Intensity-modulated radiotherapy combined with systemic atezolizumab and bevacizumab in treatment of hepatocellular carcinoma with extrahepatic portal vein tumor thrombus: A preliminary multicenter single-arm prospective study. Frontiers in Immunology (2023).
- Survival benefit of neoadjuvant hepatic arterial infusion chemotherapy followed by hepatectomy for hepatocellular carcinoma with portal vein tumor thrombus. Frontiers in Pharmacology (2023).
- Efficacy of Liver-Directed Combined Radiotherapy in Locally Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis. Cancers (2023).
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