Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus

Table 1 Transcatheter arterial chemoembolization for HCC with portal vein tumor thrombus

Lead author	Yr	n	Location of tumor thrombus	Treatment	Mortality within 1 mo (%)	Response rate (%)	Median survival time (mo)
Yamada R et al[9]	1983	9	Vp4	TACE	55.5	-	-
Okazaki M et al[10]	1991	48	Vp2	TACE	6.5	-	4.3
		56	Vp3	TACE	8	-	4
		59	Vp4	TACE	5.6	-	3.8
Raoul JL et al[14]	1994	27	Vp3, 4	131I-labeled lipiodol	0	40	6
Chung JW et al[12]	1995	110	Vp3, 4	TACE	2.7	28	6
Georgiades CS et al[13]	2005	32	Vp3, 4	TACE	0	-	9.5

Vp2: 2^nd order branches of the portal vein; Vp3: 1^st order branches of the portal vein; Vp4: the main trunk of the portal vein.

Table 2 Chemotherapy for hepatocellular carcinoma with portal vein tumor thrombus

Lead author	Yr	n	Location oftumor thrombus	Route	treatment	Response rate(CR+PR) (%)	Median survivaltime (mo)
Systemic chemotherapy
Okada S et al[26]	1992	22	Vp4	S	Tegaful, doxorubicin, MTX, CDDP, 5-FU, etc.	-	3.9
Low dose CDDP & 5-FU					Low dose CDDP & 5-FU
Ando E et al[28]	1996	9	Vp4	R	CDDP, 5-FU	44	9.2
Itamoto T et al[29]	2002	7	Vp3, 4	R	5-FU + CDDP	33	7.5
Yamasaki T et al[30]	2002	6	Vp3, 4	R	CDDP, 5-FU/+ leucovorin	0	4.5
Interferon & 5-FU
Patt YZ et al[32]	1993	291	-	S	5-FU + Interferon-α	22	-
Urabe T et al[33]	1998	16	Vp3, 4	R	MTX, 5-FU, cisplatin, Interferon-α	46.7	7
Kaneko S et al[34]	2002	34	Vp3, 4	R	5-FU, CDDP, MTX, + Interferon-α + Leucovorin	44	11 (CR + PR)
							3.5 (SD + PD)
Sakon M et al[35]	2002	8	Vp3, 4	R	5-FU + Interferon-α	63	-
Ota H et al[36]	2005	55	Vp3, 4	R	5-FU + Interferon-α	43.6	11.8
Obi S et al[37]	2005	116	Vp3, 4	R	5-FU + Interferon-α	52	6.9

¹Including all patients with HCC. S: Systemic chemotherapy; R: Regional chemotherapy via hepatic artery; MTX: methotrexate; CDDP: cisplatin.

Table 3 Radiation for hepatocellular carcinoma with portal vein tumor thrombus

Lead author	Yr	n	Location oftumor thrombus	Treatment	Response rateof PVTT (%)	Median survivaltime (mo)
Chen SC et al[41]	1994	10	Vp2	TACE for liver tumor + Radiation (30-50 Gy) for PVTT	100	-
Tazawa J et al[42]	2001	24	Vp3, 4	TACE for liver tumor + Radiation (50 Gy) for PVTT	50	CR PR; 9.7
						NC PD; 3.8
Yamada K et al[43]	2001	8	Vp3	Radiation (60 Gy) for PVTT followed by TACE for liver tumor	37.5	-
Ishikura S et al[44]	2002	20	Vp3	TACE + Radiation	50	5.3
Yamada K et al[45]	2003	19	Vp3	3-D CRT for PVTT (60 Gy) followed by TACE for liver tumor	57.9	7
Hata M et al[53]	2004	12	Vp3, 4	Proton beam therapy	100	27
				(50-72 Gy)		(24%: 5-YSR)
Nakagawa K et al[46]	2005	52	Vp2, 3, 4	3-D CRT for PVTT (60 Gy)	50	(15.2%; 3-YSR)
Zeng ZC et al[47]	2005	44		Radiation (50 Gy, 36-60)	45.5	8
Kim DY et al[50]	2005	59	Vp3, 4	3-D CRT	45.8	CR PR; 10.7
						NC PD; 5.3
Lin CS et al[48]	2006	43	Vp3, 4	Conventional: 22	Con: 75	Con: 6.0
				3-D CRT: 21	3-D CRT: 83	3-D CRT: 6.7
Hsu WC et al[49]	2006	53	Vp3, 4	3-D CRT and thalidomide	50	-

3-D CRT: Three-dimensional conformal radiation therapy; YSR: Year survival rate.

Table 4 Hepatic resection for hepatocellular carcinoma with portal vein tumor thrombus

Lead author	Yr	Number ofpatients	Location oftumor thrombus	Treatment	Operative mortalityrate (%)	5-Year survivalrate (%)	Median survivaltime (mo)
Kumada K et al[54]	1990	13	Vp4	Hx.	-	-	-
Yamaoka Y et al[55]	1992	29	Vp3, 4	Hx.	11	(11.6:3YSR)	-
Ikai I et al[56]	1998	29	Vp4	Hx.	-	4	-
		29	Vp3	Hx.	-	11	-
Ohkubo T et al[57]	2000	47	Vp2, 3, 4	Hx.	0	23.9	14
Wu CC et al[58]	2000	15	Vp4	Hx.	0	26.4	-
		97	Vp1, 2, 3	Hx.	3.1	28.5	-
Minagawa M et al[59]	2001	18	Vp2, 3, 4	TACE → Hx.	0	42	31
Fukuda S et al[60]	2002	19	Vp3, 4,	Hx. → HAI etc.	0	36.3	22.1
			Vv2, 3, B3, 4
Poon RT et al[61]	2003	20	Vp3, 4,	Hx.	5.7	13.3	6
			Vv2
Lau WY et al[62]	2004	7	Vp4	PIAF→Hx. or Yttrium 90 ia + doxorubicin iv → Hx.	4.1	56	a
Pawlik TM et al[63]	2005	102	Vp3, Vv2, 3	Hx.	5.9	10	11
Ikai I et al[64]	2006	78	Vp3, Vp4	Hx.	3.8	10.9	8.9
Le Treut YP et al[65]	2006	26	Vp3, 4, Vv2, 3	Hx.	11.5	13	9
Zhou J et al[66]	2006	381	Vp2, 3, 4	Hx.	-	12	-

^aSurvival curves remain above a survival rate of 50%. PIAF: Doxorubicin, CDDP, 5-FU iv + Interferon-α sc; Hx.: Hepatic resection; HAI: Hepatic arterial infusion chemotherapy; Vv2: The main trunk of hepatic vein; Vv3: The inferior vena cava; B3: 1^st order branches of bile duct; B4: The common hepatic duct; YSR: Year survival rate.