Safety and efficacy of TACE and gamma knife on hepatocellular carcinoma with portal vein invasion

We read with interest the article by Bruix et al 1 in which Sorafenib was regarded as the standard treatment for hepatocellular carcinoma (HCC) patients with portal vein tumour thrombosis (PVTT). However, Sorafenib can only confer 2–3 months of overall survival (OS) benefit2 ,3 and is inapplicable to many patients due to extensive side effects and high price. Zhong et al 4 proposed that liver resection might provide survival benefit to patients with HCC-PVTT with adequate liver function. However, this proposal was based on literature survey, lacked definite patient inclusion criteria and failed to provide information on patients’ baseline characteristics. Therefore, explorations of alternative therapeutics for patients with HCC-PVTT are still needed. Although not recommended by mainstream guidelines5 ,6 for patients with HCC-PVTT, transarterial chemoembolisation (TACE) has long been practiced in the clinic in selected patients with HCC-PVTT.7 ,8 Gamma knife surgery (GKS) has shown favourable effects in treating brain …