Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and a major cause of mortality. Portal vein tumor thrombosis (PVTT) arises in about 10%-40% of HCC patients, with lower rates being reported when HCC is diagnosed early, usually as a consequence of screening, and is apparent in up to 44% of patients at end of life. The median survival time of patients with portal venous invasion is significantly reduced to 2-4 months if left untreated, as compared to 10-24 months without PVTT. Optimal treatment for HCC with PVTT has not been established, and only a few randomized controlled trials have been conducted.