Successful treatment for hepatocellular carcinoma with main portal vein tumor thrombi by 3-dimensional conformal radiation therapy combined with transarterial chemoembolization

In hepatocellular carcinoma (HCC), main portal vein (MPV) tumor thrombi are considered to indicate an advanced stage. Transarterial chemoembolization (TAE) is contraindicated in patients with MPV tumor thrombi because of the risk of hepatic functional deterioration. On the other hand, 3-dimensional conformal radiation therapy (3D-CRT) can focus a high dose of radiation on a small area and seems to be suitable for targeting tumor thrombi within the portal vein. Here, we describe 2 HCC cases with MPV tumor thrombi, who were successfully treated by 3D-CRT combined with TAE. In case 1, 3D-CRT successfully eliminated tumor thrombi within the MPV, and offered the opportunity of further TAE for intrahepatic tumor. The patient remained alive 5 months after the last TAE without liver function deterioration and without a viable HCC. In case 2, following this combined therapy, intrahepatic HCC and MPV tumor thrombi regressed. However, the MPV was not recanalized and subsequently liver function deteriorated. Fortunately, thrombi remaining within the MPV did not progress, and a collateral circulation developed around the MPV. This patient remained alive 12 months after treatment without a viable intrahepatic HCC. Therefore, although 3D-CRT combined with TAE cannot be routinely recommended because of anticipated hepatic functional deterioration, it can be cautiously considered for patients with MPV tumor thrombi.