Preoperative Portal Vein Embolization and Surgical Resection in Patients with Hepatocellular Carcinoma and Small Future Liver Remnant Volume: Comparison with Transarterial Chemoembolization

Seo, Dong Dae; Lee, Han Chu; Jang, Myoung Kuk; Min, Hyun Ju; Kim, Kang Mo; Lim, Young Suk; Chung, Young‐Hwa; Lee, Yung Sang; Suh, Dong Jin; Ko, Gi‐Young; Lee, Young‐Joo; Lee, Sung‐Gyu

doi:10.1245/s10434-007-9553-y

Cited by 46 publications

(29 citation statements)

References 30 publications

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“…The safety of liver resectional surgery has been improved with the use of liver volumetry and portal vein embolization. [30][31][32][33][34][35] It is now generally accepted that patients should receive HR for HCC irrespective of the number of tumors if there is a reasonable sized functional future liver remnant left behind. Similarly, resection for a single large HCC (>10 cm) has been reported to be associated with favorable long-term survivals.…”

Section: Discussionmentioning

confidence: 99%

Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Peng

Guo

Zhang

et al. 2012

Cancer

144

163

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BACKGROUND:The long‐term survival outcomes of hepatic resection (HR) compared with transcatheter arterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) are unclear.MATERIALS AND METHODS:Between December 2002 and December 2007, 201 consecutive patients diagnosed with resectable HCC with PVTT received HR as an initial treatment in our center. These patients were compared with 402 case‐matched controls selected from a pool of 1798 patients (with a 1:2 ratio) who received TACE as an initial treatment during the study period. PVTT was classified to 4 types: PVTT involving the segmental branches of the portal vein or above (type I), PVTT extending to involve the right/left portal vein (type II), the main portal vein (type III), or the superior mesenteric vein (type IV).RESULTS:The 1‐, 3‐, and 5‐year overall survivals for the HR and TACE groups were 42.0%, 14.1%, and 11.1% and 37.8%, 7.3%, and 0.5%, respectively (P < .001). On subgroup analyses, the overall survivals for the HR group were better than the TACE group for type I PVTT, type II PVTT, single tumor, and tumor size >5 cm (P < .001, P = .002, P < .001, P < .001, respectively), but not for type III PVTT, type IV PVTT, multiple tumors, and tumor size <5 cm (P = .541, P = .371, P = .264, P = .338, P = .125, respectively). Multivariate analysis showed the type of PVTT and initial treatment allocation were significant prognostic factors for overall survival.CONCLUSIONS:Compared with TACE, HR provided survival benefits for patients with resectable HCC with PVTT, especially for those with a type I PVTT or a type II PVTT. Cancer 2012. © 2012 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Peng

Guo

Zhang

et al. 2012

Cancer

144

163

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“…However, reported outcomes suggest that major resection for HCC postPVE may yield satisfactory long-term outcome that is comparable to or even superior to major resection without PVE [12,25,26,[30][31][32][33]. This would imply that patients who would otherwise have unresectable tumors without PVE may have similar postoperative oncologic outcomes to patients with resectable tumors who did not need PVE.…”

Section: Long-term Outcomementioning

confidence: 99%

Portal Vein Embolization for Hepatocellular Carcinoma

Shindoh

Tzeng

Vauthey³

2012

Liver Cancer

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Portal vein embolization (PVE) improves the safety of major hepatectomy through hypertrophy of the future liver remnant (FLR), atrophy of the liver volume to be resected, and improvement in patient selection. Because most patients with hepatocellular carcinoma (HCC) have liver parenchymal injury due to underlying viral hepatitis or alcoholic liver fibrosis/cirrhosis, indication of PVE is relatively complex and sequential procedures, including transarterial chemoembolization, are required to maximize the effect of PVE as well as to minimize tumor progression due to increased arterial flow after PVE. PVE is currently indicated for patients with relatively well-preserved hepatic function [Child–Pugh A and indocyanine green tolerance test (ICG-R15) <20%] to achieve minimal FLR volume for safe major hepatectomy. FLR volume >40% is the minimal requirement for patients with chronic hepatitis or cirrhosis, and further strict criteria (FLR volume >50%) have been recommended for patients with marginal liver functional reserve (ICG-R15, 10–20%). Recent clinical results have suggested that PVE can be safely performed in patients with HCC and that it contributes to improved survival after major hepatectomy.

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“…Data suggests that select small extracranial tumors (either primary or metastatic tumors) may be effectively controlled using a similar approach known as stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR). Local control in excess of 75% has been reported for metastatic tumors of the spine, lung and liver, which is significantly higher than standard conventional moderate dose radiation [5,7,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Toxicity has been minimal in multiple U.S., European, and Japanese trials of SABR to the lung, liver, spine, pelvis and abdomen despite the use of very high biological equivalent doses for patients with both organ-confined and metastatic cancer.…”

Section: Introductionmentioning

confidence: 99%

A phase II randomized trial of observation versus stereotactic ablative radiation for oligometastatic prostate cancer (ORIOLE).

Phillips

Radwan

Ross

et al. 2017

JCO

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Background: We describe a randomized, non-blinded Phase II interventional study to assess the safety and efficacy of stereotactic ablative radiotherapy (SABR) for hormone-sensitive oligometastatic prostate adenocarcinoma, and to describe the biology of the oligometastatic state using immunologic, cellular, molecular, and functional imaging correlates. 54 men with oligometastatic prostate adenocarcinoma will be accrued. The primary clinical endpoint will be progression at 6 months from randomization with the hypothesis that SABR to all metastases will forestall progression by disrupting the metastatic process. Secondary clinical endpoints will include local control at 6 months post-SABR, toxicity and quality of life, and androgen deprivation therapy (ADT)-free survival (ADT-FS). Further fundamental analysis of the oligometastatic state with be achieved through correlation with investigational 18 F-DCFPyL PET/CT imaging and measurement of circulating tumor cells, circulating tumor DNA, and circulating T-cell receptor repertoires, facilitating an unprecedented opportunity to characterize, in isolation, the effects of SABR on the dynamics of and immunologic response to oligometastatic disease. Methods/design: Patients will be randomized 2:1 to SABR or observation with minimization to balance assignment by primary intervention, prior hormonal therapy, and PSA doubling time. Progression after 6 months will be compared using Fisher's exact test. Hazard ratios and Kaplan-Meier estimates of progression free survival (PFS), ADT free survival (ADT-FS), time to locoregional progression (TTLP) and time to distant progression (TTDP) will be calculated based on an intention-to-treat. Local control will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Withdrawal from the study prior to 6 months will be counted as progression. Adverse events will be summarized by type and grade. Quality of life pre-and post-SABR will be measured by Brief Pain Inventory.

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Preoperative Portal Vein Embolization and Surgical Resection in Patients with Hepatocellular Carcinoma and Small Future Liver Remnant Volume: Comparison with Transarterial Chemoembolization

Abstract: Preoperative PVE enables surgical resection in HCC patients with small FLR volume and improves patient survival compared with TACE.

Cited by 46 publications

References 30 publications

Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Portal Vein Embolization for Hepatocellular Carcinoma

A phase II randomized trial of observation versus stereotactic ablative radiation for oligometastatic prostate cancer (ORIOLE).

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