Transcatheter arterial embolization for advanced tumor thrombus with marked arterioportal or arteriovenous shunt complicating hepatocellular carcinoma.
OBJECTIVE
To evaluate the efficacy and safety of transcatheter arterial embolization with gelatin sponge immersed in an anti-cancer agent (GIA-TAE) alone or combined with radiation therapy, in hepatocellular carcinoma with portal vein tumor thrombus (PVTT) or hepatic vein tumor thrombus (HVTT) complicated by marked arterioportal or arteriovenous shunts.


METHODS
GIA-TAE was performed in 15 patients with PVTT and arterioportal shunts to the main portal trunk or first-order branch, and five with HVTT and arteriovenous shunts, adding radiation therapy in suitable cases. Primary efficacy, hemodynamic changes, Child-Pugh score, and survival rates were evaluated.


RESULTS
GIA-TAE with or without radiation therapy was effective for tumor thrombus in 11 patients with PVTT and in four with HVTT. Treatment was effective for the main tumor in eight patients with PVTT and three with HVTT. Shunts disappeared in seven of 13 patients available for follow-up. Child-Pugh scores before and after the treatment were not significantly different. Median survival times of PVTT and HVTT groups were 8.7 and 12.2 months, respectively. One-year survival rates for both groups were about 15.6% and 50.0%, respectively.


CONCLUSIONS
TAE with GIA alone or combined with radiation therapy is effective and safe for severe arteriovenous shunts with PVTT or HVTT, and also favors patient survival.
Department of Radiology, Kobe University, Graduate School of Medicine, Japan.
Kenta
K
Izaki
Koji
K
Sugimoto
Kazuro
K
Sugimura
Shozo
S
Hirota
D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications / Q000628:therapy*; D006502:Budd-Chiari Syndrome / Q000209:etiology / Q000532:radiotherapy / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D016019:Survival Analysis; D016896:Treatment Outcome