Recently, we reviewed a multicenter clinical study published by Hur et al., which included data from 216 patients collected over a 10-year period [1]. The authors and their team studied the therapeutic effects of transarterial radioembolization (TARE) and tyrosine kinase inhibitors (TKI) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). Based on the study results, the authors and their team believe that TARE, compared to TKI medications, may offer better overall survival for patients with advanced HCC who have segmental or lobular PVTT and partially retained liver function. The study by Martelletti et al. on two treatment options for HCC patients with intrahepatic PVTT yielded similar results, demonstrating that TARE is more effective than sorafenib in downstaging tumors and significantly improving survival rates in HCC patients [2]. Notably, even among patients who did not undergo surgery, the survival rate of patients in the TARE treatment group was superior to that of the sorafenib treatment group. We greatly appreciate and acknowledge the contributions made by the authors and their team in this critical field, and at the same time, we have some additional ideas and considerations for the treatment of patients with HCC.

The use of radiolabeled microspheres to treat tumors can be traced back to 1960, when the liver became the first organ to be successfully treated using this technique [3]. TARE is a treatment method that selectively delivers microspheres via the percutaneous route and achieves therapeutic effects through radiation carried by microspheres [4]. Although TARE has been studied as the primary treatment for early-, intermediate-, and advanced-stage HCC, it is still very expensive, especially in low-income countries. According to the Barcelona Clinical Liver Cancer staging system, HCC patients with PVTT are at an advanced stages [5]. Although the American Association for the Study of Liver Diseases recognizes the potential significance of TARE in advanced HCC, the European Association for the Study of the Liver does not support its usage [6].

Sorafenib is considered the standard treatment for advanced HCC; however, its clinical efficacy in HCC patients is often challenged by other interventions [7]. The Phase III randomized trial (IMbrave150) showed that compared to sorafenib, atezolizumab-bevacizumab demonstrated better overall survival in patients with unresectable HCC who had not previously received systemic therapy [8]. However, the development of second-line treatments is not rapid. Currently, sorafenib is the only drug that can be followed by an approved second-line therapy [9].

Multiple studies have been conducted on the combined application of TARE and TKI for the treatment of HCC, but the results indicate that patients have not benefited more from combination therapy [10,11]. A prospective study on the treatment of patients with advanced HCC reveals exciting outcomes [12]. After four weeks of sorafenib treatment, it is safe for patients to undergo TARE, which can improve survival rates by effectively reducing liver tumor growth. This study provides valuable insights into potential combination therapy models for patients with advanced HCC.

Finally, we would like to thank Hur et al. for their contributions in the field of treating HCC with PVTT, and look forward to the release of their latest research results.