Induction hepatic arterial infusion chemotherapy followed by surgery for hepatocellular carcinoma with massive portal vein tumor thrombosis: a case series of 20 patients.

Abstract

Background: The prognosis of hepatocellular carcinoma with portal vein tumor thrombosis is very poor, and the optimal treatment remains controversial. The aim of this study is to examine the safety and feasibility of our multimodal treatment.

Methods: This was a single-institution, retrospective case series. From 2013 to 2018, induction hepatic arterial infusion chemotherapy was given to 20 consecutive Japanese patients with hepatocellular carcinoma harboring portal vein tumor thrombosis in the main portal trunk or first branch, even with intrahepatic and extrahepatic metastasis. When the cancers including thrombus and metastatic disease were well controlled, surgical resection was considered. When macroscopic complete resection was achieved, two courses of hepatic arterial infusion chemotherapy were added as adjuvant therapy, whereas patients who had remnant disease after surgery were provided treatment according to the type of lesion.

Results: No treatment-related deaths were noted. The objective response rate and disease control rate were 35.0% and 65.0%, respectively. After induction treatment, 10 of 20 patients underwent surgery. Postoperative complications (Clavien-Dindo grade III or more) were observed in three cases, and median postoperative hospital stay was 15.5 days. Median survival time of all 20 patients was 14.5 months and that in patients who underwent surgery was significantly longer than that in patients with unresectable hepatocellular carcinoma (19.5 months versus 9.0 months, p = 0.0018).

Conclusion: Induction treatment followed by surgery was safe and feasible for hepatocellular carcinoma with massive portal vein tumor thrombosis. Surgical resection might be oncologically appropriate for selected patients after induction treatment even with advanced stage hepatocellular carcinoma.