Angiographic Findings in Patients with Hepatocellular Carcinoma Previously Treated Using Proton Beam Therapy

Abstract

Given the growing interest in using proton beam therapy (PBT) for hepatocellular carcinoma (HCC), it is possible that transarterial chemoembolization (TACE) could be used for selected patients who have previously undergone PBT. However, these cases can be technically challenging to treat and require appropriate preparation. Thus, we aimed to identify angiographic findings in this setting. We retrospectively identified 31 patients (28 men and 3 women, mean age: 69 years, range: 43–84 years) who underwent hepatic angiography plus TACE or transarterial infusion chemotherapy (TAI) for HCC that recurred after PBT (July 2007 to June 2018). We discovered four angiographic findings, which we speculate were related to the previous PBT. 18 patients experienced recurrence in the irradiated field, and 13 patients experienced recurrence outside the irradiated field. 29 patients underwent TACE and only 2 patients underwent TAI. The mean number of previous PBT treatments was 1.3 ± 0.6 (range: 1–4). The median interval from the earliest PBT treatment to hepatic angiography was 559 days (range: 34–5,383 days), and the median interval from the latest PBT treatment to hepatic angiography was 464 days (range: 34–5,383 days). Abnormal staining of the irradiated liver parenchyma was observed in 22 patients, which obscured the angiographic tumor staining in 4 patients. Development of a tortuous tumor feeder vessel was observed in 13 patients. Development of an extrahepatic collateral pathway was observed in 7 patients. Development of an arterioportal or arteriovenous shunt was observed in 4 patients. Based on these findings, we conclude that PBT was associated with various angiographic findings during subsequent transarterial chemotherapy for recurrent HCC, and familiarity with these findings will be important in developing appropriate treatment plans.

Indicator for local recurrence of hepatocellular carcinoma after proton beam therapy: analysis of attenuation difference between the irradiated tumor and liver parenchyma on contrast enhancement CT

“…During angiography, the irradiated liver parenchyma shows early and prolonged staining. 17 The irradiated parenchyma does not take up gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) and superparamagnetic iron oxide, which can cause difficulty in distinguishing PBT-treated HCCs from the surrounding irradiated parenchyma. 18,19 Thus, dynamic CT or dynamic MRI scans using extracellular contrast agents are suitable for the assessment of tumor contrast enhancement, because they can more accurately distinguish treated HCC from irradiated parenchyma.…”

Early hepatocellular carcinoma developed within dysplastic nodule as nodule-within-nodule appearance: Case report with literature review

“…Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, and its incidence is growing in many countries [1] . The leading risk factor for the development of HCC is liver cirrhosis, especially those related to chronic viral hepatitis.…”

“…The leading risk factor for the development of HCC is liver cirrhosis, especially those related to chronic viral hepatitis. (HVC/HBC) [1] .…”

“…Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver [1] . Unlike other tumors that arise in a normal tissue background, HCC occurs in the context of a change in the liver field, characterized by the replacement of liver parenchyma by fibrosis, scarring, and nodular regeneration [2] .…”

Long-Term Clinical Outcomes of Patients Receiving Proton Beam Therapy for Caudate Lobe Hepatocellular Carcinoma

“…Non-surgical treatments, including percutaneous ablation therapies such as radiofrequency ablation (RFA), are also challenging because of the narrow percutaneous puncture window and adjacent major vessels [14]. The existence of several branches of feeding arteries also complicate the treatment of caudate HCC using transcatheter hepatic arterial chemoembolization (TACE) [15][16][17]. The caudate lobe is also considered the most dangerous hepatic zone for targeting with stereotactic body radiation therapy (SBRT), especially when main portal vein tumour thrombosis (PVTT) occurs [18].…”