title: Therapeutic benefits of partial splenic embolization for thrombocytopenia in hepatocellular carcinoma patients treated with radiofrequency ablation.
abstract: OBJECTIVE
  Partial splenic embolization (PSE) is a non-surgical procedure developed to treat hypersplenism. The purpose of this study is to evaluate therapeutic benefits of PSE with follow-up radiofrequency ablation (RFA) treatment in hepatocellular carcinoma (HCC) patients with thrombocytopenia.
  
  
  METHODS
  Between September 1999 and January 2007, a total of 20 patients with HCC who had a few lesions, each 3 cm or less in diameter, and liver function of Child-Pugh class A or B were enrolled into our study. The patients were diagnosed with marked thrombocytopenia (<50 x 10(3)/mm(3)), or mild thrombocytopenia (<80 x 10(3)/mm(3)) with decreased prothrombin activity. They were treated once or twice with PSE. RFA was given as a follow-up treatment 2 weeks after final PSE. The primary endpoint was a platelet-count increase and improvement of prothrombin activity, and the secondary endpoint was the initiation of RFA.
  
  
  RESULTS
  PSE was performed successfully in 19 patients (95%). Two weeks after final PSE, platelet counts increased significantly (38 +/- 14 x 10(3)/mm(3) vs. 97 +/- 43 x 10(3)/mm(3); P < 0.0001), and prothrombin activity improved significantly (59.3 +/- 19.8% vs. 65.2 +/- 17.9%; P < 0.0001). No patients had major complications during the PSE procedure. The secondary endpoint was achieved in 18 of 19 patients (94.7%). The mean overall survival was 2257 days (95% confidence interval; range, 1659-2855 days). The Kaplan-Meier cumulative survival rate was estimated to be 61.9% at 5 years.
  
  
  CONCLUSIONS
  PSE is a safe and effective treatment for thrombocytopenia and has adjuvant therapeutic benefits for the therapy of HCC.
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University East Hospital, Sagamihara, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Hidaka
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Kokubu
authors.forename: Takahide
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Minamino
authors.forename: Juichi
authors.initials: J
authors.lastname: Takada
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okuwaki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
authors.forename: Katsunori
authors.initials: K
authors.lastname: Saigenji