Portal vein thrombosis is observed in 10–20% of patients with cirrhosis,[16] and increased with cirrhosis severity.[17] These data support our report that Child–Pugh class B was a common point of portal vein thrombosis. Zocco et al.[18] showed an association between portal vein thrombosis and high MELD score. Kim et al.[12] recently reported that MELD-Na score is more useful than MELD score alone. Guha et al.[19] recommended that the MELD-Na score should be measured when toxicity after radiation therapy to the liver is

evaluated. The MELD-Na score of CH5424802 mw the patients experienced portal vein thrombosis was 11 of higher in our report. Vascular injury is another risk factor for portal vein thrombosis.[20] Irradiation can cause vascular injury.[21, 22] D2 of the portal vein of 40 Gy or more was a common point of portal vein thrombosis in our report. High doses to the portal vein also may be a risk factor for portal vein thrombosis through vascular injury. Bile duct toxicity after SBRT for liver tumors was evaluated with dose–volume metrics in one study.[11] Two cases of bile duct stenosis were reported. One patient was treated twice with SBRT and the high-dose area of more than 80 Gy R428 clinical trial corresponded to the biliary

stenosis region. In another patient, the biliary tract was exposed to more than 20 Gy but did not correspond to the bile duct stenosis region. They concluded that SBRT with 40 Gy or less in five fractions for liver tumors was feasible with regard to biliary toxicity. In our report, bile duct of the patient who experienced bile duct stenosis was also irradiated with more than 20 Gy. Barney et al.[23] reported one case of grade 3 biliary stenosis after SBRT for cholangiocarcinoma. The patient was treated to a dose of 50 Gy in five fractions for positive resection margins after surgery for intrahepatic cholangiocarcinoma. In our report, the patient who experienced bile duct stenosis also had a history of cholangiocarcinoma and left hepatic lobectomy, although there was no evidence of recurrence of cholangiocarcinoma. In conclusion, portal vein thrombosis may be necessary

to be considered when SBRT for HCC is administrated to patients in higher Child–Pugh class MCE with higher D2 of the portal vein. “
“Background and Aims:  To evaluate and compare laparoscopic splenectomy and partial splenic embolization as supportive intervention for cirrhotic patients with hypersplenism to overcome peripheral cytopenia before the initiation of and during interferon therapy or anticancer therapy for hepatocellular carcinoma. Methods:  Between December 2000 and April 2008, 43 Japanese cirrhotic patients with hypersplenism underwent either laparoscopic splenectomy or partial splenic embolization as a supportive intervention to facilitate the initiation and completion of either interferon therapy or anticancer therapy for hepatocellular carcinoma. We reviewed the peri- and post-intervention outcomes and details of the subsequent planned main therapies.