[Transarterial chemoembolization (TACE) of the hepatocellular carcinoma (HCC) in patients with portal vein thrombosis--experiences].
OBJECTIVE
Comparative analysis of the course of disease in patients with initial diagnosis of portal vein thrombosis in HCC treated with sequential TACE. Evaluation of the efficacy and safety of the method in a selected patient cohort.


METHODS
The study included 22 patients with HCC that were palliatively treated at least 3 times with TACE. All patients presented a portal vein thrombosis in the initial CT investigation. The TACE-procedure was carried out in regular intervals using a suspension consisting of a fixed dosage of Mitomycin C (10 mg) and 10-20 ml Lipiodol. Follow-up investigations were carried out with contrast enhanced Multislice-CT before and after TACE and control of the laboratory panel (i. e. blood count, liver enzymes and coagulation).


RESULTS
Mean survival was 15.7 months (95%-CI 11.6-19.8) with a mean follow-up after last TACE of 6.1 +/- 4.8 months. The mean number of TACE procedures was 5.5 +/- 2.7. During the investigation period 17 / 22 (77.3%) patients died. In 23.5% retrospective analysis revealed a liver decompensation as the cause of death and in 58.8% patients died from the tumor disease. The cumulative 1-, 2- and 3-year survival was 55.0, 21.0 and 0%. The mean tumor size was 7.2 +/- 3.4 cm. Unifocal tumors were found in 18.2% of the cases whereas multifocal tumors were found in 81.8%. In 59.1% of the patients tumor extended to both liver lobes. In case of tumor infiltration of the portal vein survival was significantly worse compared to patients with no evidence of a tumor thrombosis (p = 0.01; cumulative 1- and 2-year survival 46% and 8% vs. 77% and 46%).


CONCLUSIONS
The palliative treatment of the HCC with TACE shows an improvement of survival. There was no increase of death due to liver decompensation in our cohort. Patients with a tumor infiltration of the portal vein showed a significantly worsened survival. The presence of a portal vein thrombosis at the initial diagnosis of the HCC is not an absolute contraindication for TACE treatment but patients have to be elected carefully with critical regard to their liver function.
Herber
S
S
Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Johannes-Gutenberg-Universität, Mainz. herber@radiologie.klinik.uni-mainz.de
Pitton
M
M
Mönch
C
C
Schneider
J
J
Manzl
N
N
Kummer
I
I
Kanzler
S
S
Schuchmann
M
M
Junginger
T
T
Düber
C
C
Otto
G
G
D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002423:Cause of Death; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009361:Neoplasm Invasiveness; D010166:Palliative Care; D018579:Patient Selection; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology
D000903:Antibiotics, Antineoplastic; D003287:Contrast Media; D016685:Mitomycin; D007459:Iodized Oil