Hepatocellular Carcinoma with Macrovascular Invasion: Defining the Optimal Treatment Strategy

Abstract

Background: Tumoral macrovascular invasion (MVI) of hepatic and/or portal vein branches is a common phenomenon in hepatocellular carcinoma (HCC) and is associated with poorer prognosis when compared to HCC without MVI. Summary: Current international guidelines for the management of HCC recommend sorafenib as the only treatment option in case of MVI. Despite guideline recommendations, several alternative options have been tested to manage HCC with MVI: surgery, transarterial chemoembolization, external or internal radiation, hepatic arterial infusion chemotherapy, percutaneous treatment, cryotherapy, or the combination of two or more of these strategies, with or without sorafenib. Here we will provide a comprehensive state-of-the-art review for the management of this challenging clinical entity based on the most recent available data. Key Messages: There is a growing body of evidence suggesting that alternative strategies to standard-of-care sorafenib might improve survival in patients with advanced HCC with MVI but the level of evidence remains weak. Randomized phase III trials are ongoing and will hopefully provide information leading towards a more personalized treatment algorithm.

Liver transplantation for hepatocellular carcinoma after successful treatment of macrovascular invasion – a multi‐center retrospective cohort study

“…Practice guidelines primarily recommend the use of sorafenib , which can lead to a modestly prolonged survival (8.1 vs. 4.9 months) . Other studies suggest the use of locoregional radiological treatments in patients with preserved liver function, and segmental or sub‐segmental portal invasion . TACE can be safe and effective, using super‐selective catheterization techniques, and resulting in a modest survival gain from 0 to 35% at 5 years .…”

Genomic analysis of small nucleolar RNAs identifies distinct molecular and prognostic signature in hepatocellular carcinoma

“…Therapeutic strategies combining surgical resection and molecular targeted treatment have provided encouraging results and improved the outcomes for HCC patients. However, the prognosis for patients with unresectable advanced-stage HCC remains poor (6,7). Sorafenib was the only systemic drug available for treating advanced HCC until the recent approval of regorafenib, another multi-kinase inhibitor (8,9).…”

Hepatocellular carcinoma with right atrial tumor thrombus: a systematic review

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