Objective
To summarize the updates of diagnosis and differential diagnosis for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) for providing evidences for early diagnosis and treatment of PVTT patients.
Methods
The related literatures on diagnosis and differential diagnosis for HCC with PVTT in recent years were collected and reviewed.
Results
The serious complications and tumor metastasis are attributed to the PVTT, then it is necessary to make diagnosis accurately according to clinical symptoms, hematological and imaging examinations. The differential diagnosis of PVTT and portal vein thrombosis, portal sponge degeneration and hepatic arteriovenous shunt diseases should be carried out.
Conclusions
The diagnosis and differential diagnosis of PVTT cannot rely on a single method, and it requires a comprehensive judgment of various diagnostic methods. More accurate and specific diagnostic methods are needed.
ObjectiveTo summarize recent advances, clinical applications, and future directions of the portal vein iodine-125 (125I) irradiation stent in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). MethodsLiterature published over the past 15 years concerning 125I irradiation stents for HCC with PVTT treatment was retrieved. Studies focusing on stent design, radiation dosimetry, combination treatment strategies, and prognostic outcomes were systematically reviewed and analyzed. ResultsThe portal vein 125I irradiation stent provides dual therapeutic benefits: mechanical recanalization of the obstructed portal vein and continuous intraluminal low-dose γ-radiation, achieving high-dose, long-duration localized irradiation. Clinical evidences indicate superior outcomes in maintaining portal vein patency, controlling tumor thrombus progression, and improving overall survival as compared with transcatheter arterial chemoembolization (TACE) or systemic therapy alone. Moreover, combination approaches with TACE or targeted or immunotherapy further enhance tumor control and survival benefits, making it an integral part of multidisciplinary HCC management. ConclusionsAs an innovative integration of interventional and brachytherapy techniques, the portal vein 125I irradiation stent shows promising efficacy and safety in treating HCC with PVTT. Future developments should emphasize biomaterial optimization, image-guided precision implantation, and individualized dosimetry, supported by multicenter randomized controlled trials to establish standardized therapeutic protocols and advance precision oncology.
Objective To summarize the effect of lenvatinib + transarterial chemoembolization (TACE) + programmed cell death protein-1 (PD-1) antibody in the treatment of hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. Methods In this study, we reported the clinical data of four patients with hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation who received conversion therapy with lenvatinib combined with TACE and PD-1 antibody in West China Hospital. Results Among the four patients, two patients achieved complete response and two achieved partial response; tumor markers were significantly decreased after combination treatment. However, all four patients failed to undergo hepatectomy. ConclusionsLenvatinib + TACE + PD-1 antibody is effective for hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. However, there are still many problems worthy of further discussion.
