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      A Review of Non-operative Treatments for Hepatocellular Carcinoma with Advanced Portal Vein Tumor Thrombus

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          Abstract

          Portal vein tumor thrombus (PVTT) frequently occurs with the progression of hepatocellular carcinoma (HCC) and is an important factor in determining the prognosis of HCC. In many cases of HCC with advanced PVTT, treatment is difficult because the tumor has considerable extension into the liver, and portal hypertension is a frequent complication. The standard therapy for unresectable HCC with advanced PVTT is sorafenib therapy in patients with good hepatic function. However, the outcomes of sorafenib therapy are not completely satisfactory, making the development of another therapy an urgent task. Therefore, this review aims to summarize non-operative treatments for HCC with advanced PVTT and discuss future perspectives based on those therapies, including therapies still being developed.

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          Most cited references34

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          Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials.

          This study analyzed the natural history and prognostic factors of patients with nonsurgical hepatocellular carcinoma (HCC). Twenty variables from 102 cirrhotic patients with HCC who were not treated within prospective randomized controlled trials (RCT) were investigated through uni- and multivariate analyses. None of them was suitable for radical therapies (surgical resection, liver transplantation, or ethanol injection) or presented end-stage disease as reflected by an Okuda stage 3 or a Performance Status >/=3. Sixty-five patients were Child-Pugh A, 34 were B, and 3 were C. Most of them exhibited a preserved Performance Status Test (PST) (0 = 56; 1 = 38; 2 = 8). Tumor was solitary in 26 (
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            Radiation-associated liver injury.

            The liver is a critically important organ that has numerous functions including the production of bile, metabolism of ingested nutrients, elimination of many waste products, glycogen storage, and plasma protein synthesis. The liver is often incidentally irradiated during radiation therapy (RT) for tumors in the upper- abdomen, right lower lung, distal esophagus, or during whole abdomen or whole body RT. This article describes the endpoints, time-course, and dose-volume effect of radiation on the liver. Published by Elsevier Inc.
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              Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion.

              The presence of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) is regarded as indicating an advanced stage, and liver resection (LR) is not recommended. The aim of this study was to evaluate the survival benefit of LR for HCC patients with PVTT through the analysis of the data from a Japanese nationwide survey.
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                Author and article information

                Journal
                J Clin Transl Hepatol
                J Clin Transl Hepatol
                JCTH
                Journal of Clinical and Translational Hepatology
                XIA & HE Publishing Inc.
                2225-0719
                2310-8819
                12 April 2017
                28 June 2017
                : 5
                : 2
                : 177-183
                Affiliations
                [1]Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science , Kyoto, Japan
                Author notes
                * Correspondence to: Michihisa Moriguchi, Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokouji, Kamigyo-ku, Kyoto 602-8566, Japan. Tel: +81-75-251-5519, Fax: +81-75-0251-0710, E-mail: mmori@ 123456koto.kpu-m.ac.jp

                Itoh Y received research grants from Esai Co., Ltd., Merck Sharp and Dohme Co., Ltd., Sumitomo Dainihon Pharma Co., Ltd., Nihon Kayaku Co., Ltd. and Bristol-Myers Squibb Company, and received lecture fees from Esai Co., Ltd., Merck Sharp and Dohme Co., Ltd., Sumitomo Dainihon Pharma Co., Ltd. and Bristol-Myers Squibb Company. Moriguchi M received a research grant from Merck Sharp and Dohme Co., Ltd.

                Reviewed, designed and wrote the manuscript (MM), collected the data (MM, MF), revised the manuscript for important intellectual content (MM, YI).

                Article
                JCTH.2016.00075
                10.14218/JCTH.2016.00075
                5472939
                8a9ee3d5-1a06-4efc-b84e-3d6db8b00d93
                © 2017 Authors.

                This article has been published under the terms of Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0), which permits noncommercial unrestricted use, distribution, and reproduction in any medium, provided that the following statement is provided. “This article has been published in Journal of Clinical and Translational Hepatology at DOI: 10.14218/JCTH.2016.00075 and can also be viewed on the Journal’s website at http://www.jcthnet.com”.

                History
                : 30 December 2016
                : 21 February 2017
                : 25 February 2017
                Categories
                Review Article

                hepatocellular carcinoma,medical therapy management,portal vein,thrombus

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