Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: Treatment with Transarterial Chemoembolization Combined with Sorafenib—A Retrospective Controlled Study

Zhu, Kangshun; Chen, Junwei; Lai, Lisha; Meng, Xiaochun; Zhou, Bin; Huang, Wensou; Cai, Mingyue; Song, Hong

doi:10.1148/radiol.14131946

Cited by 146 publications

(163 citation statements)

References 28 publications

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“…The OS of 6.0 months for sorafenib monotherapy is also lower than that reported in SHARP (Sorafenib in Advanced Hepatocellular Carcinoma) trial (OS: 10.7 months), but that study cohort only consisted of 36% patients with macroscopic vascular invasion [5]. The increased number of patients with MPVTT and underlying disease (hepatitis B and cirrhosis) in the present study might account for the poor survival, since those factors are known negative predictors for OS [14,21,22].…”

Section: Discussioncontrasting

confidence: 58%

“…This contradicts studies showing the effectiveness of TACE combined with sorafenib for advanced HCC [13][14][15]. However, the inclusion of less advanced-stage patients with MPVTT in those studies could be a possible explanation for the contradictions.…”

Section: Discussionmentioning

confidence: 92%

“…However, some reports suggested that TACE is a safe treatment for patients with advanced HCC and MPVTT if the patient has good liver function and collateral circulation around the MPV [8,10]. Moreover, there has been increased focus on combining TACE with sorafenib to potentially improve the efficacy for patients with unresectable/advanced HCC [11][12][13][14][15]. Therefore, patients with advanced HCC and MPVTT treated with the combination therapy of sorafenib and TACE are expected to show improved survival time.…”

Section: Introductionmentioning

confidence: 99%

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Sorafenib With and Without Transarterial Chemoembolization for Advanced Hepatocellular Carcinoma With Main Portal Vein Tumor Thrombosis: A Retrospective Analysis

et al. 2015

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Background. The survival benefit of combining sorafenib and transarterial chemoembolization (TACE) therapy compared with sorafenib monotherapy for patients with advanced hepatocellular carcinoma (HCC) and main portal vein tumor thrombosis (MPVTT) is unclear. Methods. Between January 2009 and June 2013, 183 consecutive patients with advanced HCC (Barcelona Clinic Liver Cancer stage C) and MPVTT were retrospectively reviewed. Of these, 89 patients with advanced HCC and MPVTT were enrolled in this study: 45 were treated with combination therapy (sorafenib‐TACE group), and the other 44 treated with sorafenib monotherapy (sorafenib group). Results. The mean number of TACE sessions per patient was 2.6 (range: 1–5). The median duration of sorafenib in the sorafenib‐TACE group and sorafenib group was 5.6 months and 5.4 months, respectively. The disease control rate was similar between the two groups. Median time to progression was 3.0 months (95% confidence interval [CI]: 2.2, 3.7) in the sorafenib‐TACE group, and 3.0 months (95% CI: 2.1, 3.8) in the sorafenib group (p = .924). Median overall survival was 7.0 months (95% CI: 6.1, 7.8) and 6.0 months (95% CI: 4.7, 7.3) in the sorafenib‐TACE group and the sorafenib group, respectively (p = .544). The adverse events related to sorafenib were comparable between the two groups. Twenty‐one adverse events of grade 3–4 related to TACE occurred in 12 patients (26.7%), and 2 of them died (4.4%). Conclusion. This study demonstrated no advantage of combination therapy over sorafenib monotherapy. Considering the patients’ morbidity after TACE, sorafenib monotherapy is appropriate for managing patients with advanced HCC and MPVTT. Implications for Practice: For patients with advanced hepatocellular carcinoma (HCC) and main portal vein tumor thrombosis (MPVTT), no benefit was seen in this study in terms of disease control rate, time to progression, and overall survival for patients receiving sorafenib and transarterial chemoembolization compared with those receiving sorafenib monotherapy. Considering the patients’ morbidity after combination therapy, monotherapy is appropriate for managing patients with advanced HCC and MPVTT.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Sorafenib With and Without Transarterial Chemoembolization for Advanced Hepatocellular Carcinoma With Main Portal Vein Tumor Thrombosis: A Retrospective Analysis

et al. 2015

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“…The combination therapy using sorafenib and TACE appears to provide a survival benefit for patients with PVTT and adequate liver function. This benefit seems to be more pronounced in patients whose first-order or more distal branches of the portal vein are involved [50] than in patients with main portal vein involvement.…”

Section: [1]mentioning

confidence: 90%

Surgical strategy for huge and advanced hepatocellular carcinoma in Hong Kong

Chok¹

2017

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How to cite this article: Chok KSH. Surgical strategy for huge and advanced hepatocellular carcinoma in Hong Kong. Hepatoma Res 2017;3:189-95. In Hong Kong, surgical resection is the core curative treatment for huge and advanced hepatocellular carcinoma (HCC). For tumors measuring 10 cm or above, major hepatectomy is usually required, but a future liver remnant not large enough will preclude the operation. Hypertrophy of future liver remnant is a way to render more patients operable, and measures include portal vein embolization and associating liver partition and portal vein ligation for staged hepatectomy. For HCC that has invaded a major vessel, en bloc resection with immediate vessel reconstruction is necessary if thrombectomy would not suffice. In case of bilobar involvement, radiofrequency ablation is a useful adjuctive therapy. In the treatment of extrahepatic metastasis, metastasectomy offers a cure to properly selected patients. Key words:Associating liver partition and portal vein ligation, staged hepatectomy, hepatocellular carcinoma, liver resection, vascular resection and reconstruction, radiofrequency ablation ABSTRACTArticle history:

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“…Zhu et al [64] conducted a retrospective study comparing the efficacy and safety of TACE plus sorafenib in 91 HCC patients accompanying PVTT (46 TACE-sorafenib vs 45 TACE alone). TACE plus sorafenib showed significant survival benefits over TACE alone in patients with Vp3 (median OS, 13 mo vs 6 mo; P = 0.002) or Vp1-2 (median OS, 15 mo vs 10 mo; P = 0.003).…”

Section: Tace Combined With Sorafenibmentioning

confidence: 99%

Effective treatment strategies other than sorafenib for the patients with advanced hepatocellular carcinoma invading portal vein

Yu¹

2015

WJH

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Patients with hepatocellular carcinoma (HCC) accompanying portal vein tumor thrombosis (PVTT) have relatively few therapeutic options and an extremely poor prognosis. These patients are classified into barcelona clinic liver cancer stage C and sorafenib is suggested as the standard therapy of care. However, overall survival (OS) gain from sorafenib is unsatisfactory and better treatment modalities are urgently required. Therefore, we critically appraised recent data for the various treatment strategies for patients with HCC accompanying PVTT. In suitable patients, even surgical resection can be considered a potentially curative strategy. Transarterial chemoembolization (TACE) can be performed effectively and safely in a carefully chosen population of patients with reserved liver function and sufficient collateral blood flow nearby the blocked portal vein. A recent meta-analysis demonstrated that TACE achieved a substantial improvement of OS in HCC patients accompanying PVTT compared with best supportive care. In addition, transarterial radioembolization (TARE) using yttrium-90 microspheres achieves quality-of-life advantages and is as effective as TACE. A large proportion of HCC patients accompanying PVTT are considered to be proper for TARE. Moreover, TACE or TARE achieved comparable outcomes to sorafenib in recent studies and it was also reported that the combination of radiotherapy with TACE achieved a survival gain compared to sorafenib in HCC patients accompanying PVTT. Surgical resection-based multimodal treatments, transarterial approaches including TACE and TARE, and TACE-based appropriate combination strategies may improve OS of HCC patients accompanying PVTT.

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Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: Treatment with Transarterial Chemoembolization Combined with Sorafenib—A Retrospective Controlled Study

Abstract: TACE-sorafenib side effects were acceptable, and this treatment may improve overall survival in patients with HCC with first-order or lower-branch PVTT when compared with patients who underwent TACE alone.

Cited by 146 publications

References 28 publications

Sorafenib With and Without Transarterial Chemoembolization for Advanced Hepatocellular Carcinoma With Main Portal Vein Tumor Thrombosis: A Retrospective Analysis

Sorafenib With and Without Transarterial Chemoembolization for Advanced Hepatocellular Carcinoma With Main Portal Vein Tumor Thrombosis: A Retrospective Analysis

Surgical strategy for huge and advanced hepatocellular carcinoma in Hong Kong

Effective treatment strategies other than sorafenib for the patients with advanced hepatocellular carcinoma invading portal vein

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