title: Percutaneous electrochemotherapy in the treatment of portal vein tumor thrombosis at hepatic hilum in patients with hepatocellular carcinoma in cirrhosis: A feasibility study.
abstract: OBJECTIVE
  To treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4- portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.
  
  
  METHODS
  Six patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae®, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrast-enhanced CT and CEUS at 3 mo after treatment and every six months thereafter.
  
  
  RESULTS
  Post-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post-treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the follow-up CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.
  
  
  CONCLUSIONS
  In patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Tarantino
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Busto
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Nasto
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Fristachi
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cacace
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Talamo
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Catello
authors.initials: C
authors.lastname: Accardo
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Bortone
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gallo
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tarantino
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Riccardo Aurelio
authors.initials: RA
authors.lastname: Nasto
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
authors.affiliation: Luciano Tarantino, Paolo Gallo, Paolo Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 84016 Pagani, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ambrosino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D053672:Electrochemotherapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011446:Prospective Studies; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy*
keywords: Electrochemotherapy; Hepatocellular carcinoma; Portal vein tumor thrombosis