Extrahepatic Collateral Artery Supply to the Tumor Thrombi of Hepatocellular Carcinoma Invading Inferior Vena Cava: The Prevalence and Determinant Factors

Lee, In Joon; Chung, Jin Wook; Kim, Hyo Cheol; Yin, Yanru; So, Young; Jeon, Ung Bae; Jae, Hwan Jun; Cho, Baik Hwan; Park, Jae Hyung

doi:10.1016/j.jvir.2008.09.030

Cited by 63 publications

(50 citation statements)

References 17 publications

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“…TACE has become an acceptable treatment for most cases of unresectable HCCs (24) and has been shown to be safe for patients with advanced HCC and IVCTT (6). However, at initial diagnosis, the extrahepatic collateral artery supply to the IVCTT can be seen in as many as 65% of patients, and this rate increases with sequential repeated TACE, making complete chemoembolization of IVCTT difficult (2,6). Furthermore, IVCTT usually accompanies marked arteriovenous shunts owing to alterations in hepatic venous structures, which also limit the efficacy of chemoembolization (25).…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 4% of patients with HCC have inferior vena cava tumor thrombus (IVCTT) at initial presentation or following repeated transarterial chemoembolization (TACE) (2). HCC with IVCTT may be complicated by lung metastasis, pulmonary infarction, secondary Budd-Chiari syndrome, ball-valve thrombus syndrome, and heart failure.…”

Section: Introductionmentioning

confidence: 99%

“…Surgical removal of the tumor thrombus may be effective but is rarely performed owing to the limited hepatic reserve of patients (4,5). Although TACE could be performed safely in these patients, its effect is unsatisfactory (2,6) Conventional radiotherapy (RT) has been infrequently used in the treatment of HCC owing to the risk of radiation-induced liver disease (RILD) after uniform whole-liver RT with the doses required to eradicate the tumor. However, recent advances in three-dimensional radiation techniques based on three-dimensional planning tools have allowed us to deliver high tumoricidal doses of RT that conform tightly to the tumor without causing dose-limiting toxicities in the surrounding normal tissue, thereby allowing RT to be used for curative-intent treatment of HCC (7,8).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Combination of Transarterial Chemoembolization and Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma With Inferior Vena Cava Tumor Thrombus

Koo

Kim

Lim

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

102

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Combination of Transarterial Chemoembolization and Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma With Inferior Vena Cava Tumor Thrombus

Koo

Kim

Lim

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

102

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“…Surgical removal of tumor thrombi is rarely performed because of the limited hepatic reserves of patients (1,2). While transarterial chemoembolization (TACE) could be performed in these patients, its effect is unsatisfactory (3,4). With advances in radiation therapy (RT) techniques, conventional external beam radiotherapy (EBRT) has become more accepted.…”

Section: Introductionmentioning

confidence: 99%

High dose radiotherapy with image-guided hypo-IMRT for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombi is more feasible and efficacious than conventional 3D-CRT

Hou

Zeng

Wang

et al. 2016

Jpn. J. Clin. Oncol.

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Objective: To compare the efficacies of conventional three-dimensional conformal radiotherapy and image-guided hypofractionated intensity-modulated radiotherapy treatments in advanced hepatocellular carcinoma patients with portal vein and/or inferior vena cava tumor thrombi. Methods: A total of 118 hepatocellular carcinoma patients with portal vein and/or inferior vena cava tumor thrombi who received external beam radiation therapy focused on tumor thrombi and intrahepatic tumors were retrospectively reviewed. During the three-dimensional conformal radiotherapy treatments, a median total dose of 54 Gy with a conventional fraction (1.8-2.0 Gy/fx) was delivered. During the image-guided hypofractionated intensity-modulated radiotherapy treatments, a median total dose of 60 Gy with fractions of 2.5−4.0 Gy/fx was delivered. Results: The median follow-up time was 11.8 months (range, 1.7-43.7 months). Higher radiation doses were delivered by image-guided hypofractionated intensity-modulated radiotherapy than by three-dimensional conformal radiotherapy (average dose 57.86 ± 7.03 versus 50.88 ± 6.60 Gy, P ≤ 0.001; average biological effective dose 72.35 ± 9.62 versus 61.45 ± 6.64 Gy, P < 0.001). A longer median survival was found with image-guided hypofractionated intensity-modulated radiotherapy than with three-dimensional conformal radiotherapy (15.47 versus 10.46 months, P = 0.005). Multivariate analysis showed that image-guided hypofractionated intensity-modulated radiotherapy is a significant prognostic factor for overall survival. Toxicity was mild for both image-guided hypofractionated intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Conclusions: High dose radiotherapy delivered by image-guided hypofractionated intensity-modulated radiotherapy appears to be an effective treatment that provides a survival benefit without increasing severe toxicity in hepatocellular carcinoma patients with portal vein and/or inferior vena cava tumor thrombi.

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“…Therefore, we believe that a larger ablation zone can be achieved following the single-session combined therapy compared with that following the dual-session combined therapy. The gelatin sponge is a temporary embolising agent, which is widely used to embolise the feeding artery during TAE [21][22][23][24][25][26]. RFA should be performed immediately after TAE for HCC to produce as large an ablation zone as possible.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation combined with transcatheter arterial embolisation in rabbit liver: investigation of the ablation zone according to the time interval between the two therapies

Lee

Kim

et al. 2012

The British Journal of Radiology

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Objectives: This study was designed to evaluate the extent of the radiofrequency ablation zone in relation to the time interval between transcatheter arterial embolisation (TAE) and radiofrequency ablation (RFA) and, ultimately, to determine the optimal strategy of combining these two therapies for hepatocellular carcinoma. Methods: 15 rabbits were evenly divided into three groups: Group A was treated with RFA alone; Group B was treated with TAE immediately followed by RFA; and Group C was treated with TAE followed by RFA 5 days later. All animals underwent perfusion CT (PCT) scans immediately after RFA. Serum liver transaminases were measured to evaluate acute liver damage. Animals were euthanised for pathological analysis of ablated tissues 10 days after RFA. Non-parametric analyses were conducted to compare PCT indices, the RFA zone and liver transaminase levels among the three experimental groups. Results: Group B showed a significantly larger ablation zone than the other two groups. Arterial liver perfusion and hepatic perfusion index represented well the perfusion decrease after TAE on PCT. Although Group B showed the most elevated liver transaminase levels at 1 day post RFA, the enzymes decreased to levels that were not different from the other groups at 10 days post-RFA. Conclusions: When combined TAE and RFA therapy is considered, TAE should be followed by RFA as quickly as possible, as it can be performed safely without serious hepatic deterioration, despite the short interval between the two procedures.

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Extrahepatic Collateral Artery Supply to the Tumor Thrombi of Hepatocellular Carcinoma Invading Inferior Vena Cava: The Prevalence and Determinant Factors

Cited by 63 publications

References 17 publications

Combination of Transarterial Chemoembolization and Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma With Inferior Vena Cava Tumor Thrombus

Combination of Transarterial Chemoembolization and Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma With Inferior Vena Cava Tumor Thrombus

High dose radiotherapy with image-guided hypo-IMRT for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombi is more feasible and efficacious than conventional 3D-CRT

Radiofrequency ablation combined with transcatheter arterial embolisation in rabbit liver: investigation of the ablation zone according to the time interval between the two therapies

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