Safety and Efficacy of Transarterial Chemoembolization in Patients with Unresectable Hepatocellular Carcinoma and Portal Vein Thrombosis

Georgiades, Christos; Hong, Kelvin; D’Angelo, Michael; Geschwind, Jean François H.

doi:10.1097/01.rvi.0000182185.47500.7a

Cited by 200 publications

(112 citation statements)

References 17 publications

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“…In this sense, portal vein thrombosis (PVT) may be analogous to the presence of a TIPS, where the parenchyma relies exclusively on arterial perfusion. While there have been some series demonstrating safety of chemoembolization in the setting of PVT [17], PVT has been described as a relative contraindication to chemoembolization [1]. Therefore, theoretically, a TIPS may be a relative contraindication to chemoembolization.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

Padia

Chewning

Kogut

et al. 2014

Cardiovasc Intervent Radiol

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Purpose Locoregional therapy for hepatocellular carcinoma (HCC) can be challenging in patients with a transjugular intrahepatic portosystemic shunt (TIPS). This study compares safety and imaging response of ablation, chemoembolization, radioembolization, and supportive care in patients with both TIPS and HCC. Methods This retrospective study included 48 patients who had both a TIPS and a diagnosis of HCC. Twenty-nine of 48 (60 %) underwent treatment for HCC, and 19/48 (40 %) received best supportive care (i.e., symptomatic management only). While etiology of cirrhosis and indication for TIPS were similar between the two groups, treated patients had better baseline liver function (34 vs. 67 % Child-Pugh class C). Tumor characteristics were similar between the two groups. A total of 39 ablations, 17 chemoembolizations, and 10 yttrium-90 radioembolizations were performed on 29 patients.Results Ablation procedures resulted in low rates of hepatotoxicity and clinical toxicity. Post-embolization/ ablation syndrome occurred more frequently in patients undergoing chemoembolization than ablation (47 vs. 15 %). Significant hepatic dysfunction occurred more frequently in the chemoembolization group than the ablation group. Follow-up imaging response showed objective response in 100 % of ablation procedures, 67 % of radioembolization procedures, and 50 % of chemoembolization procedures (p = 0.001). When censored for OLT, patients undergoing treatment survived longer than patients receiving supportive care (2273 v. 439 days, p = 0.001). Conclusions Ablation appears to be safe and efficacious for HCC in patients with TIPS. Catheter-based approaches are associated with potential increased toxicity in this patient population. Chemoembolization appears to be associated with increased toxicity compared to radioembolization.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

Padia

Chewning

Kogut

et al. 2014

Cardiovasc Intervent Radiol

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“…The World Health Organization and the Response Evaluation Criteria in Solid Tumors depend on tumor size reduction to indicate a favorable response to treatment. 24,25,30 However, as most tumors do not decrease in size even after successful treatment, surrogate measures of tumor response, such as lack of contrast enhancement on CT or MRI and lipiodol deposition, have been used to determine tumor necrosis. 2,26,27,[31][32][33] By using the Response Evaluation Criteria in Solid Tumors and the aforementioned surrogate measures in the present study, a favorable response was achieved in 55% (27 of 49) of our patients.…”

Section: Discussionmentioning

confidence: 99%

“…Tumor size was measured by electronic calipers as the maximum diameter of the largest targeted index lesion, as proposed by the Response Evaluation Criteria in Solid Tumors (Table 2). 24,25 Repeated treatment was indicated when new or residual tumor was detected. Treatment was terminated if a patient could not tolerate the procedure because of a decline in clinical status.…”

Section: Follow-upmentioning

confidence: 99%

Transcatheter arterial chemoembolization or chemoinfusion for unresectable intrahepatic cholangiocarcinoma

Kim

Yoon

Sung

et al. 2008

Cancer

107

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BACKGROUND.The role of transcatheter arterial chemoembolization (TACE) or transcatheter arterial chemoinfusion (TACI) for unresectable intrahepatic cholangiocarcinoma (ICC) has recently been questioned. The aim of the study was to evaluate the clinical efficacy of TACE or TACI in patients with unresectable ICC and to identify prognostic factors associated with clinical success.METHODS.From 1997 to 2007, 49 patients with unresectable ICC were treated with TACE (n = 124) or transcatheter arterial chemoinfusion (TACI) (n = 96). Tumor response was evaluated based on computed tomography scans obtained 1 month to 3 months after TACE or TACI. Factors associated with clinical success were evaluated using multivariate logistic regression analysis. Factors associated with the survival period were evaluated using multivariate Cox regression analysis.RESULTS.After treatment, 27 (55%) of the patients showed radiographic response. Multivariate analysis confirmed that tumor vascularity (odds ratio [OR], 31.2; P = .002) was the only independent factor associated with radiographic response. The median and mean survival periods in our study patients were 12 and 24 months. Multivariate Cox regression analyses showed that tumor size (OR, 2.64; P = .048), tumor vascularity (OR, 13.5; P < .001), and the Child‐Pugh class (OR, 3.65; P = .014) were the independent factors associated with the length of the survival period.CONCLUSIONS.Hepatic intra‐arterial chemotherapy is well tolerated and may be effective to prolong survival of patients with unresectable ICC. Tumor vascularity is significantly associated with radiographic response. Large tumor size, tumor hypovascularity, and Child‐Pugh class B were poor prognostic factors for determining the patient survival period. Cancer 2008. © 2008 American Cancer Society.

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“…A portal vein thrombus, which is present in 8% to 26% of HCC patients, was initially considered an absolute contraindication. Several studies have now demonstrated that with alterations in technique, TACE can be safely and efficaciously performed in the setting of main portal vein thrombosis, 13,14 particularly when there is established collateral circulation and there is good hepatic reserve. In concordance with these findings, our study did not establish a statistically significant association between irreversible hepatotoxicity and portal vein flow abnormalities such as portal vein thrombosis, hepatofugal flow in the portal vein, or a patent TIPS.…”

Section: Survival Analysismentioning

confidence: 99%

Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

et al. 2012

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The purpose of this study was to determine the rate and risk factors for the development of irreversible hepatotoxicity after transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) and synthetic hepatic dysfunction. Two hundred fifty-one consecutive patients with HCC and hepatic dysfunction who underwent 443 TACE procedures from 2005 to 2010 were retrospectively reviewed. The included patients met one of the following criteria: a pre-TACE bilirubin level 2 mg/dL, an international normalized ratio (INR) > 1.5, a creatinine level > 1.2 mg/dL, a platelet count 60,000/ mL, a Model for End-Stage Liver Disease (MELD) score > 15, Child-Turcotte-Pugh class B or C, ascites, or portal vein thrombosis. Hepatotoxicity was defined as new or worsening ascites, encephalopathy, or grade 3 or 4 toxicity (bilirubin, aspartate aminotransferase, alanine aminotransferase, creatinine, or INR) according to the National Cancer Institute Common Terminology Criteria for Adverse Events. The rate and risk factors for death or urgent liver transplantation within 6 weeks of TACE and irreversible hepatotoxicity were determined with a generalized estimating equation analysis. Reversible hepatotoxicity developed after 90 procedures (20%) in 78 patients (31%). Irreversible hepatotoxicity developed after 41 procedures (9%) in 37 patients (15%). Six patients (2%) underwent urgent liver transplantation, and 11 (4%) died within 6 weeks of TACE. Patients at increased risk for procedure-related mortality or urgent liver transplantation within 6 weeks of TACE had a baseline serum bilirubin level 4.0 mg/dL (P ¼ 0.01), an elevated INR (P < 0.001), hypoalbuminemia with an albumin level < 2.0 g/L (P ¼ 0.01), a serum creatinine level > 2.0 mg/dL (P ¼ 0.02), large ascites (P ¼ 0.002), encephalopathy (P ¼ 0.005), or a MELD score 20 (P < 0.001). In conclusion, TACE can be performed safely in patients with baseline hepatic dysfunction. However, a poor hepatic reserve increases the risk of irreversible hepatotoxicity, which may lead to death or the need for urgent liver transplantation. Transarterial chemoembolization (TACE) is a standard treatment option for patients with unresectable, intermediate-stage hepatocellular carcinoma (HCC) without significant hepatic synthetic dysfunction.1 TACE produces an objective tumor response rate of 35% to 40% and confers a significant survival advantage in

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Safety and Efficacy of Transarterial Chemoembolization in Patients with Unresectable Hepatocellular Carcinoma and Portal Vein Thrombosis

Cited by 200 publications

References 17 publications

Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

Transcatheter arterial chemoembolization or chemoinfusion for unresectable intrahepatic cholangiocarcinoma

Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction

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