title: Complete hepatocellular carcinoma necrosis following sequential porto-arterial embolization.
abstract: Most patients with hepatocellular carcinoma (HCC) are not eligible for curative treatment, which is resection or transplantation. Two recent series have emphasized the potential benefits of preoperative arterio-portal embolization prior to surgical resection of such tumours. This preoperative strategy offers a better disease free survival rate and a higher rate of total tumor necrosis. In case of non resectable HCC it is now widely accepted that transarterial chemoembolization (TACE) leads to a better survival when compared to conservative treatment. Thus, the question remains whether combined portal vein embolization (PVE) may enhance the proven efficiency of TACE in patients with unresectable HCC. We herein report the case of a 56-year-old cirrhotic woman with a voluminous HCC unsuitable for surgical resection. Yet, complete tumour necrosis and prolonged survival could be achieved after a combined porto-arterial embolization. This case emphasizes the potential synergistic effect of a combined arterio-portal embolization and the hypothetical survival benefit of such a procedure, in selected patients, with HCC not suitable for surgery or local ablative therapy.
authors.affiliation: Department of Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université Descartes, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Zalinski
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.forename: Bruto
authors.initials: B
authors.lastname: Randone
authors.forename: Olivier
authors.initials: O
authors.lastname: Vignaux
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
mesh_terms: D001859:Bone Neoplasms / Q000556:secondary; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic; D017809:Fatal Outcome; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local; D011172:Portography; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome