Locoregional Therapies for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

SIMPLE SUMMARY: Liver cancer is a leading cause of cancer deaths in the United States and is frequently complicated by a condition called portal vein tumor thrombus, which indicates advanced disease with a short life expectancy. Recent advances in treatment of portal vein tumor thrombus have been shown to improve life expectancy in multiple trials and the evidence supporting these treatments is reviewed here. ABSTRACT: Hepatocellular carcinoma is the fourth leading cause of cancer worldwide, and the fastest increasing cause of cancer mortality in the United States. Its propensity for vascular invasion leads to the presence of portal vein tumor thrombus in up to half of patients. PVTT results in a classification of advanced disease, given the risk recurrence secondary to intravascular spread, and formal guidelines recommend systemic therapy in these patients. However, recent advances in locoregional therapies including TACE, TARE, and ablation have demonstrated the potential to drastically improve overall survival in patients with HCC complicated by PVTT.