Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) marks an advanced stage of the disease. This stage comes with few treatment options and a poor outlook. The presence of PVTT often prevents effective treatments like surgery and liver transplants. Locoregional therapies, such as transarterial chemoembolization, also carry a high risk of liver failure. Recently, improvements in external beam radiotherapy (EBRT) techniques have sparked renewed interest in its use for HCC patients with PVTT. Modern radiotherapy can precisely target the tumor in the portal vein while reducing exposure to healthy liver tissue. This review summarizes the reasons for using EBRT in HCC with PVTT. It outlines commonly used radiotherapy techniques, discusses how to select patients, and safety profiles reported in the literature. Available evidence shows that EBRT can significantly shrink the portal vein tumor thrombus, improve local tumor control, relieve symptoms, and provide modest survival benefits in carefully chosen patients. Additionally, EBRT can be safety combined with systemic therapies in a team-based treatment approach. Though most data come from retrospective studies and have their limitations, the consistent clinical benefits observed support the use of EBRT as a valuable treatment for unresectable HCC with PVTT. Future prospective studies are needed to better define the best treatment strategies and patient selection.
C. Sugavanam*1, M. Ranjith2, K. Rithika2, S. Priyadharshini1, V. Anushree1 (Mon,) studied this question.