Transarterial chemoembolization in patients with hepatocellular carcinoma beyond Barcelona?Clinic Liver Cancer? B and portal veintumor thrombosis: Experience from a tertiary care center

Backg round: Transar terial chemoembolization (TACE) is the prefer red treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) without portal vein tumor thrombosis (PVTT). However, select patients with advanced HCC and with PVTT have shown improved survival with TACE. This study was undertaken to evaluate the outcome of TACE in patients with HCC beyond Barcelona-Clinic Liver Cancer- B (BCLC - B) and those with HCC and PVTT. Methods: Patients with unresectable HCC, subjected to TACE were included. HCC patients with PVTT involving main portal vein and, poor performance status were excluded from the study. Patients were stratified according to performance status, alpha feto protein (AFP) values, and up-to-seven criteria. Individually and using various combinations, the influence of these variables on survival was also estimated. Results: A total of 50 patients were included in the study. PVTT was present in 12 patients. Clinically, significant liver failure was observed in two patients. The average overall survival of patients beyond BCLC-B following TACE was 13 months. Survival was not influenced by tumor invasion into the portal vein. Patients with higher AFP levels had comparable survival provided their tumor load was satisfying up-to-seven criteria. Conclusion: We conclude that TACE could improve survival in selective HCC patients beyond BCLC-B and with PVTT not extending to the main portal vein

Comparison of Radioembolization and Sorafenib for the Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Systematic Review and Meta-Analysis of Safety and Efficacy

OBJECTIVE: To compare the safety and efficacy of radioembolization with that of sorafenib for the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). MATERIALS AND METHODS: MEDLINE, EMBASE, and Cochrane databases were searched for studies reporting outcomes in patients with HCC and PVTT treated with radioembolization or sorafenib. Meta-analyses of cumulative overall survival (OS) and Kaplan-Meier survival rates according to the time to progression (TTP) and incidence of adverse events (AEs) were performed. Subgroup analyses were conducted on 1-year OS data. RESULTS: Seventeen studies were identified (four involving radioembolization, 10 involving sorafenib, and three comparing both). Pooled OS rates were higher in the radioembolization group, notably at 6 months {76% (95% confidence interval [CI], 64–85%) vs. 54% (95% CI, 45–62%)} and 1 year (47% [95% CI, 38–57%] vs. 24% [95% CI, 18–30%]); TTP was also longer with radioembolization. In patients undergoing radioembolization, the proportion of patients with Eastern Cooperative Oncology Group status 0 (p < 0.0001), Child-Pugh A (p < 0.0001), extrahepatic metastasis (p = 0.0012), and a history of cancer treatment (p = 0.0048) was identified as a significant source of heterogeneity for the 1-year OS. Radioembolization was associated with a lower incidence of grade 3/4 AEs than sorafenib (9% [95% CI, 3–27%] vs. 28% [95% CI, 17–43%]). CONCLUSION: Compared with sorafenib, radioembolization is a safer and more effective treatment for HCC with PVTT and is associated with prolonged survival, delayed tumor progression, and fewer grade 3/4 AEs.

Hepatocellular carcinoma with portal vein tumor thrombosis: deficiencies in the currently available classifications / 中华消化外科杂志

There are two international classifications for hepatocellular carcinoma with portal vein tumour thrombosis (HCC with PVTT):the Cheng's Classification and the Liver Cancer Study Group of Japan.These two classifications are quite similar.Personally Ⅰ prefer the Cheng's Classification for 2 reasons:(1) it is not easy to differentiate Vpl and Vp2 in the Japanese Classification;and (2) the Japanese Classification does not have a stage for PVTT that extends to the superior mesenteric vein,i.e.the Cheng's Type Ⅳ.The main defect of these two classifications is that both classifications consider only the extent of PVTT without considering other factors which impact on treatment and prognosis.I apply some important prognostic factors used in the Barcelona Clinic Liver Cancer (BCLC) Classification for liver cancer onto the Cheng's Classification of HCC with PVTT,to come up with a new Lau-Cheng Classification.These factors include:(1) the general condition of the patient,the liver functional status and whether there is any serious associated medical diseases;(2) extrahepatic metastasis;(3) main PVTT;(4) resectability of the primary liver cancer;(5) combination with microvascular invasion (MVI).This new classification divides HCC with PVTT into the very early stage (MVI only),early stage (resectable HCC with PVTT),intermediate stage (not resectable),late stage (wlth extrahepatic metastases),and terminal stage (poor general condition,decompensated liver function,or associated with serious medical diseases).The early,intermediate and late stages can further be divided into A and B according to whether the main portal vein is not involved or is involved by PVTT.All these different stages of HCC with PVTT have their own recommended treatment and prognosis.This new classification needs to be supported by clinical data before it can be used.

Transcatheter arterial chemoembolization for hepatocellular carcinoma complicated by portal vein tumor thrombosis: prognostic analysis / 介入放射学杂志

Objective To investigate the potential prognostic factors in patients with hepatocellular carcinoma (HCC) complicate by portal vein tumor thrombosis (PVTT) who are treated with transcatheter arterial chemoembolization (TACE). Methods The complete clinical data of a total of 46 patients with HCC complicate by PVTT, who were treated with TACE during the period from January 2010 to March 2016, were retrospectively analyzed. Clinical material database was established. Kaplan-Meier test was adopted to analyze the survival rate and the COX risk ratio model was used to screen out the independent prognostic factors. Life table method was employed to calculate the survival time. Results The 6-, 12-, 18- and 24-month survival rates were 51. 2％, 28. 9％, 23. 4％ and 10. 2％, respectively. The median survival time was 6. 7 months. According to mRECIST standard, complete remission (CR) was obtained in one patient (2. 1％), partial remission (PR) in 11 patients (23. 9％), stable disease (SD) in 16 patients (34. 8％) and progress disease (PD) in 18 patients (39. 2％). Multivariate analysis indicated that local tumor response, ascites, cholinesterase, and arteriovenous fistula were the independent factors affecting the prognosis. Conclusion The independent prognostic factors that affect the survival time of HCC patient include local tumor response, ascites, cholinesterase and arteriovenous fistula. (J Intervent Radiol, 2018, 27: 266-271)

ALPPS may be an effective method for the treatment of low future liver remnant HCC patients with portal vein tumor thrombus / 国际外科学杂志

Objective To provide the practical experience of association of liver partition and portal vein ligation for staged hepatectomy(ALPPS) procedure in portal vein tumor thrombosis(PVT) cases,and to explore its value in PVTT therapy.Methods Three cases of ALPPS were applied to PVTT in Department of Hepatobiliary Surgery of PLA General Hospital from 2015 to 2016.The patients data were retrieved and analyzed retrospectively,including the basic information,preoperative PVTT classification,preoperative Child-Pugh classification,ICG test results,future liver remnant (FLR),FLR growth rate between 2 phase operation,operation time,bleeding volume,postoperative complications,postoperative survival etc.We discussed the detail technology and discuss the surgical procedure combine our experience and the published papers.Results ALPPS was performed successfully in all 3 patients.According to the Cheng's Classification of PVTT,they were classified as type Ⅱ,1 case and Ⅲ type,2 cases.Preoperative liver function was Child-Pugh A grade,average ICG R15 was 7.3％ (4.2％-11.0％),and average FLR was 387 ml (333-484 ml).The mean time interval between 2 phases surgery was 24.7 days (9-50 days) and the average FLR growth rate was 50.3％ (24.4％-82.3％).Morbidity of Clavien-Dindo Ⅲ or more was recorded in 1 case,but no mortality occurred.During follow-up period,2 patients were treated with TACE for tumor recurrence.All patients survived with acceptable life quality till now.The portal vein tumor thrombosis necrosis was observed in all 3 specimens.Conclusions ALPPS is a valuable surgery for effective control of tumor thrombus and radical resection rate in well selected PVVT type Ⅱ and type Ⅲ patients.It is expected to improve the therapeutic effect in combination with TACE and other treatment methods.

Clinical values of contrast-enhanced ultrasound in diagnosis and classification of portal vein tumor thrombosis / 吉林大学学报(医学版)

Objective:To explore the clinical application values of contrast-enhanced ultrasound in the diagnosis and classification of portal vein tumor thrombosis (PVTT)by comparing with enhanced CT.Methods:43 patients with PVTT confirmed by clinic and pathology were selected, and the accuracy rates of the diagnosis and clinic classification of contrast-enhanced ultrasound and enhanced CT were compared. Results:The characteristic of PVTT in contrast-enhanced ultrasound was“quick in fast out”;88.4% (38/43)of PVTT were hyper-enhancement in the arterial phase, 81.4% (35/43 ) of PVTT were hypo-enhancement in the vein phase, and all tumor thrombosis showed hypo-enhancement in the delay phase. The diagnostic accuracy rate of contrast-enhanced ultrasound in PVTT was 100%,and the accuracy rate of enhanced CT was 97.7% (42/43).The classification accuracy rate of contrast-enhanced ultrasonic was 95.3% (41/43),and the accuracy rate of enhanced CT was 93.0% (40/43 );there was no statistically significant difference between two methods (P > 0.05 ). Conclusion:Dynamiccontrast-enhanced ultrasonography can display the blood perfusion characteristics of PVTT, and displays the actual infiltrating tumor thrombosis. Ultrasonic imaging and enhanced CT in the qualitative diagnosis of PVTT and clinical classification have a good consistency.Contrast-enhanced ultrasound can be used as an important imaging method to evaluate the PVTT before treatment.

Survival outcomes of hepatic resection compared with transarterial chemoembolization or sorafenib for hepatocellular carcinoma with portal vein tumor thrombosis

BACKGROUND/AIMS: Treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR), transarterial chemoembolization (TACE), and sorafenib therapy as treatments for HCC with PVTT. METHODS: Patients diagnosed as HCC with PVTT between January 2000 and December 2011 who received treatment with sorafenib, HR, or TACE were included. Patients with main PVTT, superior mesenteric vein tumor thrombosis, or Child-Turcotte-Pugh (CTP) class C were excluded. The records of 172 patients were analyzed retrospectively. HR, TACE, and sorafenib treatment were performed is 40, 80, and 52 patients respectively. PVTT was classified as either involving the segmental branch (type I) or extending to involve the right or left portal vein (type II). RESULTS: The median survival time was significantly longer in the HR group (19.9 months) than in the TACE and sorafenib groups (6.6 and 6.2 months, respectively; both p<0.001), and did not differ significantly between the latter two groups (p=0.698). Among patients with CTP class A, type I PVTT or unilobar-involved HCC, the median survival time was longer in the HR group than in the TACE and sorafenib groups (p=0.006). In univariate analyses, the initial treatment method, tumor size, PVTT type, involved lobe, CTP class, and presence of cirrhosis or ascites were correlated with overall survival. The significant prognostic factors for overall survival in Cox proportional-hazards regression analysis were initial treatment method (HR vs. TACE: hazard ratio=1.750, p=0.036; HR vs. sorafenib: hazard ratio=2.262, p=0.006), involved lobe (hazard ratio=1.705, p=0.008), PVTT type (hazard ratio=1.617, p=0.013), and CTP class (hazard ratio=1.712, p=0.012). CONCLUSIONS: Compared with TACE or sorafenib, HR may prolong the survival of patients with HCC in cases of CTP class A, type I PVTT or unilobar-involved HCC.

Locoregional Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) have a extremely poor prognosis. According to the Barcelona Clinic Liver Cancer guideline, sorafenib is a standard therapy in this situation, but many clinicians still select locoregional therapy (LRT) such as transarterial therapy, external beam radiation therapy (EBRT), even surgical resection (SR) or combination of LRTs because the survival improvement by sorafenib is unsatisfactory. Based on recent meta-analysis and prospective study, transarterial chemoembolization (TACE) and transarterial radioembolization seem to be effective and safe therapeutic option that have comparable outcome to sorafenib. Recently large nationwide studies demonstrated that SR can be a potentially curative treatment in selected patients. Hepatic arterial infusion chemotherapy (HAIC) can be also good option, especially in Child class B patients based on small volume prospective studies. Moreover, multidisciplinary strategies based on the combination of LRTs (SR plus TACE, TACE + EBRT, TACE + Sorafenib, HAIC + EBRT etc.) may improve survival of HCC patients with PVTT. Finally we discuss individualized and tailored treatment strategies for different clinical situations.

New progress in treatment of hepatocellular carcinoma with portal vein tumor thrombus / 临床肝胆病杂志

Portal vein tumor thrombus (PVTT) is one of the common manifestations in patients with advanced hepatocellular carcinoma (HCC). It is the decisive factor leading to severe complications and causes extremely poor prognosis. With the development of molecular biology and imaging techniques, both single and combined therapy modalities, including surgical resection, embolization and chemotherapy, radiation therapy, a variety of ablation therapies, and molecular targeted therapy, have achieved substantial progress. However, there are no guidelines for reasonable and effective treatments. In this paper, new progress in the treatment of HCC with PVTT in recent years is summarized to provide a standardized approach for future treatment options.

Comprehensive interventional treatment of hepatocellular carcinoma with portal vein tumor thrombosis / 临床肝胆病杂志

Portal vein tumor thrombosis (PVTT) often occurs in advanced hepatocellular carcinoma (HCC) patients. PVTT may cause tumor dissemination, liver failure, and portal hypertension, thus leading to intractable ascites, variceal rupture, and hepatic encephalopathy, which will result in a poor prognosis. According to the Barcelona Clinic Liver Cancer Staging System, sorafenib is recommended as the first-line treatment for advanced HCC with PVTT, but its application in China has been limited due to its mild efficacy and high price. Nowadays, interventional treatment is widely used in the treatment of advanced HCC with PVTT due to the advantages of minimal invasiveness and repeatability and shows good efficacy. At present, the main methods of interventional treatment include hepatic arterial infusion chemotherapy, transcatheter arterial chemoembolization (TACE), TACE combined with sorafenib, TACE combined with ablation, TACE combined with three-dimensional conformal radiotherapy, TACE combined with portal vein stent placement, endovascular implantation of iodine-125 seeds strand, and transjugular intrahepatic portosystemic shunt. It is pointed out that multimodality treatment is expected to achieve good efficacy in the treatment of advanced HCC with PVTT.

Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus / 临床肝胆病杂志

Portal vein tumor thrombus (PVTT) is one of the important biological characteristics of hepatocellular carcinoma (HCC), and also a serious complication and a metastatic mode. Surgical treatment is still the most effective therapy for HCC with PVTT. This article describes the history and present situation of surgical treatment of HCC with PVTT, the anatomical basis for PVTT formation, classification of PVTT, indications for surgery, selection of surgical approaches, and evaluation of the surgical outcome of PVTT. Individualized multidisciplinary treatment should be developed based on evidence-based medicine, which might be the right direction for the treatment of HCC with PVTT.

125Iodine seed implantation and gamma knife for the treatment of portal vein tumor thrombosis in hepatocellular carcinoma：comparison of therapeutic efficacy / 介入放射学杂志

Objective To compare the therapeutic efficacy of 125Iodine seed implantation and gamma knife in treating portal vein tumor thrombosis (PVTT) in hepatocellular carcinoma (HCC), and to discuss their clinical applications. Methods Between January 2009 and May 2013, a total of 60 HCC patients associated with PVTT were encountered at authors’ hospital. The patients were divided into gamma knife group (n=30) and 125Iodine seed group (n = 30). Gamma knife treatment was carried out for the patients of gamma knife group. A total of 3 - 10 target points were designed. Single dose of 3 - 6 Gy per fraction was used and 2 - 5 times radiotherapy every week were conducted. The total treatment dose was 30 - 50 Gy. In designing the therapeutic scheme, 50%-70%of iso-dose curve contained PTV. 125Iodine seed implantation was performed for the patients of 125Iodine seed group. After the treatment, the change of PVTT size was assessed. The clinical efficacy was evaluated. Results Three months after the treatment, in gamma knife group complete remission (CR) was seen in 0 patient (0%), partial remission (PR) in 8 patient (26.6%), stable disease (SD) in 17 patients (56.7%) and progressive disease (PD) in 5 patients (16.7%). In 125Iodine seed group, CR was obtained in 3 patients (10.0%), PR in 19 patients (63.4%), SD in 7 patients (23.3%) and PD in one patient (3.3%). Statistically significant differences in responding the therapy existed between the two groups (P < 0.05), although no significant difference in the improvement of ascites and hepatic function existed between the two groups (P<0.05). Conclusion For the treatment of portal vein tumor thrombosis of hepatocellular carcinoma, the short-term efficacy of 125Iodine seed implantation is much better than that of gamma knife, although its long-term effect needs to be further studied.

The current situation and prospect of radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis / 中华肝胆外科杂志

The incidence of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is very high,and the prognosis is often unsatisfactory.Currently,some therapy such as radiotherapy or radiation combined with interventional therapy are effective and worth attention.Radiation therapy was divided into external beam radiation therapy and internal beam radiation therapy according to different administration pathway.This article summarized the current situation and prospect of radiotherapy.

Impact of treatment strategies on patients with hepatocellular carcinoma of less than 10 cm but with portal vein tumor thrombus / 中华肝胆外科杂志

Objective To evaluate the impact of different treatment strategies on patients with hepatocellular carcinoma (HCC) of less than 10 cm but with portal vein tumor thrombus (PVTT),and to investigate the prognostic factors.Methods Between 2003 and 2008,338 HCC patients with PVTT from the Affiliated Tumor Hospital,Guangxi Medical University,were retrospectively studied.These patients were divided into four groups:the conservative treatment group (n =75),the transarterial chemoembolization (TACE) group (n=86),the surgical resection group (n =90) and the surgical resection with postoperative TACE group (n=87).Survival rates were analyzed by the Kaplan-Meier method and differences among groups were compared using the log-rank analysis.The Cox' s proportional hazards model was performed to explore the risk factors of survival.Results The mean survival periods of patients in the four groups were 3.8,7,8.2,15.1 months respectively.There were significant differences in survival rate among the 4 groups.The survival rates at 1-,2-,and 3-year in the surgical resection with postoperative TACE group were 49％,37％ and 19％,which were significantly higher than the other 3 groups (P＜0.05).The 1-,2-,and 3-year survival rates in the surgical resection group were 28％,20％ and 15％ compared with 17.5％,0％ and 0％ in the TACE group.The survival rates were significantly higher after surgical resection than TACE (P＜0.05).The 1-,2-,and 3-year survival rates in the conservative treatment group were 0％.These were the lowest among the four groups (P＜0.05).Univariate analysis indicated that portal vein occlusion by tumor thrombus was a significant predictor of poor prognosis.Multivariate analysis revealed that the strategy of treatment (TACE) and the number of TACE cycles were independent survival predictors for HCC patients with PVTT.Conclusions Surgical resection is the most effective therapeutic strategy for HCC patients with PVTT and with good liver functional reserve.Postoperative TACE is necessary in preventing recurrence and prolonging survival in patients who could tolerate chemoembolization.TACE should be recommended as an effective and safe treatment for unresectable HCC patients with PVTT.The treatment provided a significantly better survival than conservative treatment.

Expression and clinical significance of peroxiredoxin Ⅰ in hepatocellular carcinoma with portal vein tumor thrombosis / 中华肝胆外科杂志

Objective To investigate the expression of peroxiredoxin 1 (Prx 1) in hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) and to evaluate the relationship between the expressions of Prx 1 and the postoperative recurrence of this disease. Methods Immunohisto chemistry and Western blotting were performed to examine the expression of Prx 1 protein in 40 patients with HCC with PVTT. Experiments on Sprague Dawley (SD) rat hepatoma model were further carried out to observe the pathological changes of Prx 1 by immunohistochemistry. Clinical outcomes were analyzed to find a correlation between the recurrence and positive rate of Prx 1. Results The expression level of Prx 1 was significantly up-regulated in primary tumor tissues than in tumor thrombosis samples (P＜0.01). Immunohistochemistry results showed that the positive rate of Prx 1 in primary tumor tissues were higher than that in tumor thrombosis. Western blotting confirmed a same trend in the level of Prx 1, the average luminosity of the blots were 1534.2 and 735.6, respectively. There was a significant difference in SD rat hepatoma model, the 4, 8, 12, 16, 20 and 24-week positive rates of Prx 1 in liver tumor tissues were 60%, 80%, 75% ,65%, 40% and 25% respectively. Clinical outcomes showed that the time to first postoperative recurrence of Prx 1 in the primary tumor positive group was significantly higher than that in the negative group (6. 3 vs 3. 7 months, P＜0. 01). Conclusions Prx 1 protein was down-regulated in HCC with PVTT. There was a negative correlation between the expression of Prx 1 and recurrence.

Prognostic Index for Portal Vein Tumor Thrombosis in Patients with Hepatocellular Carcinoma Treated with Radiation Therapy

We performed a retrospective review of 281 hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) treated with radiation therapy (RT) between 1998 and 2008 to develop a prognostic model for those patients. Of the 281 patients, PVTT and intrahepatic main masses completely disappeared in 10 patients (3.6%), and shown a partial response in 141 patients (50.2%). The median survival was 11.6 months. Patients who had more than PR have shown significantly longer survival than the others (22.0 months vs 5.0 months, P < 0.001). On the multivariate analysis, pre-treatment poor prognosticators for overall survival were ECOG performance status, Child-Pugh class, multiple tumors, main PVTT, complete portal vein occlusion, lymph node metastasis, and primary tumor size. Prognostic index of RT for PVTT of HCC (PITH) scores were defined as the number of pre-treatment poor prognostic factors. PITH scores correlated well with overall survival. In the analysis of 1 and 2 yr overall survival rate, patients who had PITH scores of 3 or greater showed a significantly lower rate of overall survival than the others (33.0%, 17.3% vs 70.1%, 40.8%, respectively, P < 0.001). The PITH scoring model, proposed in the current study in HCC patients with PVTT, reliably predict overall survival.

Pathological Complete Remission of Advanced Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombosis by Hepatic Arterial Infusion Chemotherapy

Cures for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) are rare and difficult. We report a case of pathologically confirmed complete remission of HCC induced by hepatic arterial infusion chemotherapy (HAIC). A 45-year-old male patient had a massive HCC in the right lobe of the liver and tumor thrombus in the right and main portal veins. He achieved a partial response after two cycles of HAIC with 5-fluorouracil (750 mg/m2) and cisplatin (25 mg/m2). After the completion of six cycles he received a curative partial hepatectomy, and histopathology revealed complete necrosis without any viable tumor cell. He was in good health at a 4-month follow-up. These results suggest that this regimen is a promising therapeutic modality for the treatment of advanced HCC with PVTT.

A case of advanced hepatocellular carcinoma with portal vein tumor invasion controlled by percutaneous ethanol injection therapy / 대한간학회지

Portal vein invasion is a grave prognostic indicator in the setting of hepatocellular carcinoma (HCC). There is currently no effective method for preventing the invasion of HCC into the main portal vein. We report here a case of advanced HCC with portal vein tumor thrombosis that was effectively treated with percutaneous ethanol injection (PEI), having previously enabled subsequent successive transarterial chemoembolization (TACE). A 60-year-old male patient was diagnosed with a huge HCC, based on computed tomography and angiographic findings. Despite two sessions of TACE, the tumor invaded the right portal vein. PEI was performed on the malignant portal vein thrombosis, and three sessions thereof reduced the extent of tumor thrombi in the portal vein. Successive TACEs were performed to treat the HCC in the hepatic parenchyma. The patient was still living 19 months after the first PEI with no evidence of tumor recurrence, and his liver function remained well preserved.

Efficacy of Transarterial Chemolipiodolization with or without 3-Dimensional Conformal Radiotherapy for Huge HCC with Portal Vein Tumor Thrombosis / 대한간학회지

BACKGROUND/AIMS: The treatment efficacy for advanced hepatocellular carcinoma is poor. This study examined the efficacy and toxicity of 3-dimensional conformal radiotherapy (3D-CRT) in combination with transarterial chemolipiodolization (TACL) for a huge hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). METHODS: From March 2001 to November 2004, 49 patients with advanced HCC with PVTT (size>8 cm, modified UICC stage IVa) were enrolled in this retrospective study. Twenty two patients underwent more than 2 cycles of TACL (adriamycin 50 mg/m2, cisplatin 60 mg/m2, 5-fluorouracil 200 mg/m2 every 4-6 weeks) without 3D-CRT, while 27 patients underwent consecutive TACL with 3D-CRT (40-45 Gy for 4-5 weeks) that was started one week after the 1st TACL. The response was assessed by a computed tomography (CT) and the serum alpha-fetoprotein (AFP) level at 1-2 month intervals. RESULTS: The objective response rates in the TACL group and TACL with 3D-CRT group were 18% and 48% at 3 months (P=0.051), and 10.5% and 42% at 6 months (P=0.024) respectively. The median survival time was 13 months and 13.5 months in TACL and TACL with 3D-CRT groups, respectively (P=0.502). The treatment response was better in the TACL with 3D-CRT group but there was no significant difference in survival between the two groups. Most toxicities in the two groups were mild, not exceeding grade 1 according to the WHO criteria. CONCLUSIONS: For patients with a huge HCC with PVTT, TACL with 3D-CRT achieved some meaningful clinical benefit. Prospective controlled trials will be needed to confirm the real benefit of TACL combined with 3D-CRT.