Chemoembolization related to good survival for selected patients with hepatocellular carcinoma invading segmental portal vein

Abstract

TACE was well-tolerated and effective in selected patients with HCC with segmental PVTT. We found that four risk factors were associated with decreased length of patient survival after TACE: a major tumour burden (up-to-11 criteria out), extrahepatic spread, Child-Pugh class B liver function and nonregression to TACE. TACE may not be recommended for HCC patients with segmental PVTT with 2-4 risk factors because of poor survival outcome.

Imaging Predictors of Survival in Patients with Single Small Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

“…The TACE procedure performed in our institution has been described previously (13,14). Cisplatin-based TACE was performed using a cisplatin dose of 2 mg/kg body weight.…”

“…Cisplatin-based TACE was performed using a cisplatin dose of 2 mg/kg body weight. Using a microcatheter, an emulsion of iodized oil (Lipiodol®, Guerbet) and cisplatin at a 1:1 ratio was infused into the segmental, subsegmental, or more peripheral-level feeding artery, followed by embolization with Gelfoam slurry (Upjohn) until arterial flow stasis was achieved (13,14).…”

Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma

“…Before the 15 minutes cisplatin or adriamycin infusion, some cisplatin or adriamycin was set aside to be mixed at a 1:1 ratio in an emulsion of iodized oil (lipiodol; Guerbet, Roissy, France), which was infused into the segmental, subsegmental, or more peripheral level feeding artery, followed by embolization with Gelfoam slurry (Upjohn, Kalamazoo, MI) until a near stasis of arterial flow. [12,13] The dose of iodized oil depended on the tumor size and ranged 3-20 mL. The emulsion of iodized oil and cisplatin or adriamycin was slowly injected until the accumulation of the emulsion in the tumor and the visualization of the portal vein branches near the tumor.…”

“…The emulsion of iodized oil and cisplatin or adriamycin was slowly injected until the accumulation of the emulsion in the tumor and the visualization of the portal vein branches near the tumor. [12][13][14][15] If there was a significant arterioportal shunt, embolization with a Gelfoam slurry was first performed to occlude the shunt, after which the iodized oil/ cisplatin or adriamycin emulsion was infused and embolization with a Gelfoam slurry was performed. [12][13][14] This embolization was performed to minimize the ischemic toxicity of the non-targeted normal liver parenchyma and to minimize vascular complications due to the repeated endovascular procedures.…”

“…[12][13][14][15] If there was a significant arterioportal shunt, embolization with a Gelfoam slurry was first performed to occlude the shunt, after which the iodized oil/ cisplatin or adriamycin emulsion was infused and embolization with a Gelfoam slurry was performed. [12][13][14] This embolization was performed to minimize the ischemic toxicity of the non-targeted normal liver parenchyma and to minimize vascular complications due to the repeated endovascular procedures. [16] On-demand subsequent TACE was performed 6-10 weeks following previous TACE if residual viable tumor was obvious upon dynamic CT or MRI unless there was evidence of major vascular invasion, extrahepatic spread or deterioration of liver functions as indicated by a Child-Pugh-Turcotte score higher than 8.…”