title: Portal vein thrombosis and arterioportal shunts: effects on tumor response after chemoembolization of hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization.
  
  
  METHODS
  A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology, Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements.
  
  
  RESULTS
  The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively.
  
  
  CONCLUSIONS
  TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.
authors: Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
authors: Thomas J
authors: TJ
authors: Vogl
authors: Nour-Eldin
authors: NE
authors: Nour-Eldin
authors: Sally
authors: S
authors: Emad-Eldin
authors: Nagy Nn
authors: NN
authors: Naguib
authors: Joerg
authors: J
authors: Trojan
authors: Hans
authors: H
authors: Ackermann
authors: Omar
authors: O
authors: Abdelaziz
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011169:Portal Vein / Q000473:pathology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology*