ReviewThe strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus

•The current consensus is that the portal vein tumor thrombus (PVTT) is difficult to treat and the prognosis is poor.•This paper comprehensively introduces the strategies for treating primary hepatocellular carcinoma (HCC) with PVTT.•Based on the type of PVTT, the comprehensive treatment scheme of multidisciplinary and multiple methods should be taken.

PurposeTo further improve the effectiveness and prognosis of primary hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT), the current status of treatment for HCC with PVTT was reviewed.MethodsA Medline search was undertaken to identify articles using the keywords “HCC”, “PVTT” and “therapy”. Additional papers were identified by a manual search of the references from the key articles.ResultsPVTT, as a common complication of HCC, was divided into type I ∼ IV. The therapeutic approach is mainly composed of five types: surgical resection, regional interventional therapy, radiotherapy, combination therapy, targeted therapy. All of these therapeutic approaches were separately evaluated in detail.ConclusionsFor those resectable tumors, the better choice for treatment of HCC with PVTT should be hepatectomy and removal of PVTT. For those unresectable tumors, TACE (especially the super-selective TACE) has been the preferred palliative treatment, the other regional interventional therapy and/or radiotherapy could improve the therapeutic effects. The multidisciplinary treatments may further improve the quality of life and prolong the survival period for the HCC patients associated with PVTT.