Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts.
OBJECTIVE
Locoregional therapy for hepatocellular carcinoma (HCC) can be challenging in patients with a transjugular intrahepatic portosystemic shunt (TIPS). This study compares safety and imaging response of ablation, chemoembolization, radioembolization, and supportive care in patients with both TIPS and HCC.


METHODS
This retrospective study included 48 patients who had both a TIPS and a diagnosis of HCC. Twenty-nine of 48 (60%) underwent treatment for HCC, and 19/48 (40%) received best supportive care (i.e., symptomatic management only). While etiology of cirrhosis and indication for TIPS were similar between the two groups, treated patients had better baseline liver function (34 vs. 67% Child-Pugh class C). Tumor characteristics were similar between the two groups. A total of 39 ablations, 17 chemoembolizations, and 10 yttrium-90 radioembolizations were performed on 29 patients.


RESULTS
Ablation procedures resulted in low rates of hepatotoxicity and clinical toxicity. Post-embolization/ablation syndrome occurred more frequently in patients undergoing chemoembolization than ablation (47 vs. 15%). Significant hepatic dysfunction occurred more frequently in the chemoembolization group than the ablation group. Follow-up imaging response showed objective response in 100% of ablation procedures, 67% of radioembolization procedures, and 50% of chemoembolization procedures (p = 0.001). When censored for OLT, patients undergoing treatment survived longer than patients receiving supportive care (2273 v. 439 days, p = 0.001).


CONCLUSIONS
Ablation appears to be safe and efficacious for HCC in patients with TIPS. Catheter-based approaches are associated with potential increased toxicity in this patient population. Chemoembolization appears to be associated with increased toxicity compared to radioembolization.
Section of Interventional Radiology, Department of Radiology, University of Washington Medical Center, 1959 NE Pacific St., Box# 357115, Seattle, WA, 98195, USA, spadia@uw.edu.
Siddharth A
SA
Padia
Rush H
RH
Chewning
Matthew J
MJ
Kogut
Christopher R
CR
Ingraham
Guy E
GE
Johnson
Renuka
R
Bhattacharya
Sharon W
SW
Kwan
Wayne L
WL
Monsky
Sandeep
S
Vaidya
Daniel S
DS
Hippe
Karim
K
Valji
D000328:Adult; D000368:Aged; D001918:Brachytherapy; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012189:Retrospective Studies; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
D015021:Yttrium Radioisotopes