Portal stent with endovascular brachytherapy improves the efficacy of TACE for hepatocellular carcinoma with main portal vein tumor thrombus

Hepatocellular carcinoma(HCC)with portal vein tumor throm-bus(PVTT)yields poor prognosis with a median overall survival(OS)of 2.7–4 months[1].Once PVTT develops in the main portal vein,the sudden appearance of portal hypertension often leads to fatal complications,including esophagogastric variceal hemorrhage,refractory ascites,and liver failure.Transarterial chemoemboliza-tion(TACE)has been recommended for advanced HCC patients by China Liver Cancer Group due to its benefit of OS compared with using sorafenib alone[2].For the treatment of PVTT,portal stent with endovascular iodine-125 brachytherapy(PSEIB)was re-cently reported to be effective because it relieved portal hyper-tension rapidly and controlled PVTT effectively with an improved OS of 9.3–12.5 months[3,4].The combination of PSEIB and TACE had been applied in some studies[3,4].Nevertheless,these studies failed to demonstrate the effect of PSEIB on TACE results.Herein we aimed to present a case how PSEIB improves the efficacy of TACE for HCC patients with main PVTT.