title: Intraperitoneal metastases after transarterial embolization of hepatocellular carcinoma: An observational study.
abstract: Transarterial embolization is frequently used to treat local hepatocellular carcinoma (HCC). While various complications are known to occur following transarterial embolization, only one prior case of peritoneal spread of HCC occurring shortly after transarterial chemoembolization has been reported. We present five cases of peritoneal spread of HCC following transarterial embolization (including bland embolization, conventional transarterial chemoembolization (TACE), and doxorubicin-eluting beads TACE) and identify features common among those cases.
  
  
  
  Search of electronic radiology reports and images identified five patients with imaging before and after treatment of HCC with transarterial embolization and with newly developed peritoneal metastases after treatment. Various patient demographics and tumor characteristics were noted.
  
  
  
  The mean maximal diameter of the treated HCC tumors was 3.7 cm (range 1.4-11.9 cm). Three of the patients had ascites and treated tumors in the posterior right hepatic lobe, and all patients had subcapsular tumors treated with transarterial embolization before developing peritoneal metastases. The mean time from treatment with transarterial embolization to the development of peritoneal metastases was four months.
  
  
  
  Intraperitoneal metastatic disease should be considered a rare but potential complication of transarterial embolization of subcapsular HCC, particularly in patients with ascites and tumors that are in the posterior segments of the right lobe. This potential complication should perhaps be considered when planning transarterial HCC treatment, and radiologists interpreting imaging after transarterial embolization of HCC should assess for peritoneal metastases.
authors.affiliation: Department of Radiology, University of Colorado Denver School of Medicine, 12401 E 17th Avenue, Mail Stop L954, Aurora, CO, 80045, USA. jeffrey.meier@ucdenver.edu.
authors.forename: Jeffrey M
authors.identifier: 0000-0002-6305-6162
authors.initials: JM
authors.lastname: Meier
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California San Francisco School of Medicine, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
authors.forename: Spencer C
authors.initials: SC
authors.lastname: Behr
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California San Francisco School of Medicine, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Jordan
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California San Francisco School of Medicine, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
authors.forename: K
authors.initials: K
authors.lastname: Pallav Kolli
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California San Francisco School of Medicine, 505 Parnassus Avenue, San Francisco, CA, 94143, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Yeh
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000556:secondary*; D016461:Chemoembolization, Therapeutic; D004317:Doxorubicin / Q000008:administration & dosage; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000556:secondary*; D016896:Treatment Outcome
chemical_list: D004317:Doxorubicin
keywords: Hepatocellular carcinoma; Peritoneal metastases; Transarterial chemoembolization; Transarterial embolization