HCC with portal vein tumor thrombosis: how to manage?
- PDF / 713,535 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 59 Downloads / 220 Views
EDITORIAL
HCC with portal vein tumor thrombosis: how to manage? Naoki Kawagishi1,2 Received: 6 July 2020 / Accepted: 4 September 2020 © Asian Pacific Association for the Study of the Liver 2020
The existence of the portal vein tumor thrombus (PVTT) showed a terribly poor prognosis for the hepatocellular carcinoma (HCC) patients in the past decades. However, latest clinical studies elucidate that the hepatic resection introduces a good prognosis for some selected cases with less severe PVTT. Moreover, some adding treatment options, such as interventional therapies and systemic agents, could improve the overall survival of the patients with severe forms of PVTT. Although the treatment of the HCC with PVTT is controversial due to the variety of the situations, the best survival is predicted with the hepatic resection [1–7]. So the hepatic resection should be considered at first for the patients with relatively preserved liver functions, and younger generations without extrahepatic metastasis (Fig. 1). If the patient is difficult with the surgical operation, such as too small remnant liver after resection, cardiac or respiratory distress for operation, poor performance status, and old generations, the other options should be selected. The cases with extensive tumor thrombus in the superior mesenteric vein or splenic vein accompanied with collaterals are also contraindications for the hepatic resection. The next step for the decision for the treatment is to clarify the classifications of the PVTT. The cases with up to second-order branch PVTT should be considered for transarterial chemoembolization (TACE) after the diagnosis of contraindications for hepatic resection. The patients with over first-order branch should be considered for hepatic arterial infusion chemotherapy (HAIC) or systemic therapy like sorafenib or newly arising agents. Without the consideration of the classification of the PVTT, stereotactic body radiotherapy (SBRT) or transarterial radioembolization (TARE) is the candidate for the treatment * Naoki Kawagishi [email protected] 1
Division of Transplant Surgery, JCHO Sendai Hospital, 3‑16‑1 Tsutsumi‑machi, Aoba‑ku, Sendai 981‑8501, Japan
Division of General Medicine, Imakane Town National Health Insurance Hospital, 17‑2 Azaimakane, Imakane 049‑4318, Japan
2
after the decision of withdrawing the hepatic resection. If the treatments, such as hepatic resection, TACE, SBRT, and TARE, could reduce the main tumor size and disappear of the PVTT, liver transplantation would be the candidate for the next step in some selected patients. And hepatic resection or radiofrequency ablation (RFA) after the downstaging by TACE, SBRT, TARE, and HAIC also would be possible for the selected cases. If the tumor has disappeared after the first treatment for the HCC with the PVTT, anti-HBV or anti-HCV therapy should be introduced aggressively. Even if it becomes Child–Pugh C after the first anti-cancer treatment, direct antiviral agent (DAA) therapy for HCV is possible [8]. Unfortunately, the patient whose l
Data Loading...
