Novel treatment strategy for advanced hepatocellular carcinoma: combination of conventional transcatheter arterial chemoembolization and modified method with portal vein occlusion for cases with arterioportal shunt: a preliminary study

Abstract

Background A novel strategy to combine conventional transcatheter arterial chemoembolization (TACE) and TACE during portal vein occlusion (TACE-PVO) in the presence of high-flow arterioportal shunt (APS) has been developed to treat hepatocellular carcinoma (HCC) with portal invasion. Purpose To evaluate the efficacy of this strategy. Material and Methods Twenty-five cases of HCC with portal invasion, treated between April 2006 and December 2015, were evaluated. Balloon occlusion of the portal venous outlet was performed in eight cases of high-flow APS when performing TACE. Conventional TACE was performed in the other 17 cases. The primary endpoint was overall survival. Adverse events and deterioration of liver function were also evaluated. Results The median survival time (MST) was 12 months. One-, two-, and three-year survival rates were 48.0%, 39.3%, and 26.2%, respectively. Subgroup analysis and multivariate analysis revealed the CLIP score as prognostic factor. MST was 2.5 months in the subgroup with CLIP score ≥4 and 26.0 months in the subgroup with CLIP score ≤3 (hazard ratio = 7.7, 95% confidence interval = 2.3-25.8). Transient elevations of the levels of transaminase and bilirubin were observed; however, deterioration of liver function was infrequent; upgrading of Child-Pugh class in 9.1% of cases. Conclusion A novel strategy, combining conventional TACE and TACE-PVO, is effective for HCC with portal invasion. The CLIP score may be useful for considering treatment indication.

<p>Safety and efficacy assessment of transarterial chemoembolization using drug-eluting beads in patients with hepatocellular carcinoma and arterioportal shunt: a single-center experience</p>

“…Several studies have reported that APS is a poor prognostic factor in HCC patients because such patients are often associated with portal hypertension, refractory ascites, bleeding of esophageal and gastric varices, and hepatic encephalopathy 1–4. Due to the high risk of developing hepatic failure in patients with HCC and APS, cTACE is sometimes contraindicated 15. To the best of our knowledge, there is no standard treatment for the embolization of APS to date, and various embolic materials have been introduced, such as coils, gelatin sponges, absolute ethanol, glue, balloon-assisted embolization devices, and PVA particles 3,4,7–9,16–19.…”

TIPS plus sequential systemic therapy of advanced HCC patients with tumour thrombus-related symptomatic portal hypertension

“…Based on the results of this research, a therapeutic strategy was given preference for better treatment of patients with stable intrahepatic tumours and severe SPH. Two cases of tumour thrombus–related portal hypertension were caused by arterioportal fistula due to tumour invasion, which is called “dynamic portal hypertension” [ 36 , 37 ]. The portal vein pressure in such cases is usually very high because of the connection between the hepatic artery branches and the portal vein.…”

Assessment of hepatocellular carcinoma treatment response with LI-RADS: a pictorial review

“…Although arterial supply of a liver segment is compromised after embolization, a patent portal axis compensates hepatocytes perfusion thus reducing damage to healthy liver. Transarterial embolization in the setting of portal thrombosis or invasion is relatively contraindicated although it can be performed if other therapies are unavailable [38].

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