title: Sequential intra-arterial therapy and portal vein embolization is feasible and safe in patients with advanced hepatic malignancies.
abstract: BACKGROUND
  A major hepatic resection for malignancies requires an adequate post-operative liver reserve. Portal vein embolization (PVE) with intra-arterial therapy (IAT) may increase future liver remnant (FLR) hypertrophy. As such, the feasibility, safety and efficacy of IAT+PVE were investigated.
  
  
  METHODS
  Between 2000 to 2011, 86 patients with malignancy of the liver were identified from a multi-institutional database. Twenty-nine patients underwent sequential IAT+PVE, 25 had PVE alone and 32 had IAT alone. Clinicopathological data were evaluated.
  
  
  RESULTS
  Most patients had hepatocellular carcinoma (HCC) (65.1%) and 31.4% had secondary metastatic disease. A complete or partial response using European Association for the Study of the Liver (EASLD) criteria was seen in 48.3% of patients undergoing IAT+PVE vs. 56.6% among patients undergoing IAT (P = 0.601). The median increase in percentage FLR volume was comparable in IAT+PVE (7.4%) vs. PVE only (7.9%) (P = 0.203). There were no IAT+PVE-associated deaths and only one complication. Among patients treated with IAT+PVE (n = 29), 27 underwent a subsequent hepatic resection. Peri-operative morbidity and mortality was 29.6% and 7.4%, respectively. Among the patients with HCC who underwent curative intent surgery after IAT+PVE, the median survival was 59.0 months.
  
  
  CONCLUSIONS
  Sequential IAT and PVE are feasible and safe. Utilization of IAT+PVE before a resection can lead to long-term survival and should be considered in the treatment of patients with advanced hepatic malignancies.
authors: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Peter D
authors: PD
authors: Peng
authors: Omar
authors: O
authors: Hyder
authors: Mark
authors: M
authors: Bloomston
authors: Hugo
authors: H
authors: Marques
authors: Celia
authors: C
authors: Corona-Villalobos
authors: Elijah
authors: E
authors: Dixon
authors: Carlo
authors: C
authors: Pulitano
authors: Kenzo
authors: K
authors: Hirose
authors: Richard D
authors: RD
authors: Schulick
authors: Eduardo
authors: E
authors: Barroso
authors: Luca
authors: L
authors: Aldrighetti
authors: Michael
authors: M
authors: Choti
authors: Feng
authors: F
authors: Shen
authors: Ihab
authors: I
authors: Kamel
authors: Jean-Francois H
authors: JF
authors: Geschwind
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002681:China; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005060:Europe; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011169:Portal Vein; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult