Effect of Transarterial Chemoembolisation in Unresectable Hepatocellular Carcinoma with Portal Vein Tumour Thrombosis: Single-centre Study

Abstract

Objectives: To determine the effect of transarterial chemoembolisation (TACE) on liver function and procedurerelated mortality in patients with unresectable hepatocellular carcinoma (HCC) and portal vein tumour thrombosis (PVTT). Methods: This was a retrospective study of patients with HCC and PVTT who underwent TACE from January 2012 to December 2013 at a single tertiary medical centre in Hong Kong. Patient demographics, aetiology of cirrhosis, alpha fetoprotein (AFP) level, tumour size, number of tumours, liver function (total bilirubin, albumin, international normalised ratio [INR]), and Child-Pugh score were evaluated before and 4 weeks after TACE. The 30-day mortality was also recorded. Results: TACE was performed in 26 patients with unresectable HCC and PVTT (mean age, 61 years). The mean total bilirubin level before and after TACE was 18.2 μmol/l and 26.8 μmol/l (p = 0.140), respectively, and mean albumin level fell from 36.8 g/l to 33.9 g/l (p = 0.009). The respective mean INR before and after TACE was 1.1 and 1.2 (p = 0.120), the AFP level was 35,364.0 ng/ml and 37,424.5 ng/ml (p = 0.563), and the mean Child-Pugh score was 6.0 and 6.6. The mean and median survival of patients was 5.1 months (range, 1.5-8.8 months) and there was no 30-day mortality. Conclusion: TACE has a deteriorating effect on liver function in patients with unresectable HCC and PVTT. Nonetheless since there were no procedure-related deaths and TACE has potential survival benefits, it should be a treatment option along with superselective catheterisation of tumour feeding vessels for patients with HCC and PVTT.

Target localization of 3D versus 4D cone beam computed tomography in lipiodol-guided stereotactic radiotherapy of hepatocellular carcinomas

“…The tumor volume ranged from 10 to 1100 cc (median = 186 cc). One to two cycles of first–line TACE was given to these patients one week prior to 4D–CT simulation [16]. Individualized dose fractionation of either 4 Gy for 6–10 fractions or 6–9 Gy for 6 fractions was prescribed according to estimated risk of RILD [17,18].…”