Downstaging treatment of hepatocellular carcinoma with portal vein tumor thrombus

Hepatocellular carcinoma with portal vein tumor thrombus has a high incidence rate and rapid progression,and there are limited therapies with a poor clinical effect. Although sorafenib is recommended as the sole therapy for such patients in foreign guidelines,studies have shown that some patients may achieve a better outcome via surgical treatment,especially those with tumor thrombus in the first-or second-order branches of the portal vein( type Ⅰ/Ⅱ thrombus according to Cheng's classification). However in clinical practice,a large proportion of patients cannot undergo radical resection due to extensive lesions,or there may be a high possibility of residual tumor thrombus after surgery due to the presence of tumor thrombus in the main portal vein( type Ⅲ according to Cheng's classification),and therefore,downstaging resection is needed to improve prognosis. Studies have shown that with the help of palliative therapies including neoadjuvant three-dimensional conformal radiotherapy,( 90) Y-loaded microsphere radioembolization,and hepatic arterial infusion chemotherapy,some patients may achieve regression or disappearance of portal vein tumor thrombus,tumor shrinkage,and disappearance of satellite lesions,which helps to achieve tumor downstaging,increase surgical resection rate,and prolong survival time. Multidisciplinary therapy is of vital importance in improving downstaging resection rate in patients with hepatocellular carcinoma and portal vein tumor thrombus.