Imaging findings and transcatheter arterial chemoembolization of hepatic malignancy with right atrial embolus in 46 patients

Cheng, Hongyan; Wang, Xiaoyan; Zhao, Guoli; Chen, Dong

doi:10.3748/wjg.14.3563

Cited by 8 publications

(11 citation statements)

References 11 publications

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“…In addition, the median survival time was 11 months, and long-term survival exceeding 2 years was achieved for 4 (21.1%) of the 19 recorded patients, compared with the natural prognosis reported at 6-7.2 months in patients with a TT extending into the right atrium without medical therapy. 5,18,19 Cheng et al 19 reported an average survival time of 8.4 months in 17 patients who received transcatheter arterial chemoembolization (TACE) treatment. Moreover, Chern et al 20 reported that the median survival time of patients who underwent TACE was 4.2 months.…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma with right atrial tumor thrombus: Report of a case

et al. 2011

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Hepatocellular carcinoma (HCC) with a tumor thrombus (TT) extending into the right atrium is generally regarded as a terminal-stage condition. We report a case of long-term survival following treatment of this complication with en bloc hepatectomy and resection of the thrombus under cardiopulmonary bypass. Our review of 19 similar cases reported in the literature found the following: that lung metastasis, the most critical prognostic factor, occurred in only 5 (27.8%) patients; that postoperative survival ranged from 18 days to 56 months, with a median survival of 11 months; and that 7 (38.9%) patients showed no signs of recurrence, with 4 (21.1%) surviving longer than 2 years. Thus, to prevent sudden death and extend the survival of patients with HCC and TT extending into the right atrium, we advocate simultaneous en bloc resection performed under cardiopulmonary bypass, provided distant metastasis and recurrence in the remnant liver are controlled.

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Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma with right atrial tumor thrombus: Report of a case

et al. 2011

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“…Advanced HCC presenting with extensive intravascular tumor thrombi is a rare condition and is considered as a terminal stage of HCC (19)(20)(21). The majority of patients with terminal-stage HCC receive no anticancer treatment and typically succumb to the disease within a few months of diagnosis, with a median survival time of 2.0-3.5 months (11,22). The most appropriate treatment for patients with HCC metastases to the RA remains controversial (8)(9)(10)12,13,15,16,19,23).…”

Section: Discussionmentioning

confidence: 99%

Effective hepatic artery chemoembolization for advanced hepatocellular carcinoma with multiple tumor thrombi and pulmonary metastases: A case report

Huang

Luo

et al. 2016

Oncology Letters

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Advanced hepatocellular carcinoma (HCC) with tumor thrombi invading the portal vein and extending into the right atrium (RA) through the hepatic vein is regarded as a terminal-stage condition. Intracardiac tumor thrombus and treatment via liver resection has been reported in the current literature, but results from this therapeutic approach remain unsatisfactory. The present study describes a rare case of HCC with metastatic portal vein, middle hepatic vein, inferior vena cava (IVC) and RA tumor thrombi, and pulmonary metastases. A 29-year-old woman was admitted to The First Affiliated Hospital of Guangxi Traditional Chinese Medical University (Nanning, China) subsequent to experiencing right upper quadrant abdominal pain. Following diagnosis, based on computed tomography analysis and laboratory data, the patient underwent an initial transcatheter arterial chemoembolization (TACE) treatment using fluorouracil (5-FU), pirarubicin, mitomycin C, Lipiodol and sodium alginate microball (KMG). At 1 month post-treatment, serum α-fetoprotein levels remained at >1,000 ng/ml. Subsequently, the patient underwent a second TACE treatment. At 1 month after the second treatment, the abdominal pain had been alleviated and the serum α-fetoprotein levels were reduced to <20 ng/ml. Imaging analysis indicated a marked reduction in tumor burden in the liver and the hepatic vein and IVC tumor thrombi. Furthermore, the portal vein and RA tumor thrombi, and the pulmonary metastases had disappeared. At 40 months after the second TACE therapy, the patient remains alive without any signs of recurrence. The present case demonstrates that the administration of TACE, using 5-FU, pirarubicin, mitomycin C, Lipiodol and KMG, functions as an effective treatment in cases of unresectable advanced HCC presenting with pulmonary metastases and extensive tumor thrombi in the IVC, the RA and one branch of the portal vein.

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“…A typical angiography of the abdominal cavity and hepatic artery exhibits 'thread and streaks sign' and 'asymmetric dumbbell sign' for TT in the IVC or RA (20). TT in the IVC or RA is associated with intrahepatic lesions through the HV.…”

Section: Dsamentioning

confidence: 99%

“…A previous study revealed that the fastest growth rate of TT was 4.0 cm over 1 month, and the slowest growth rate was 3.0 cm over 6 months. The average reported growth rate is 3.7 cm over 3.2 months (20). Tumors in the right hepatic lobe usually invade the right HV and directly affect the IVC.…”

Section: Pathophysiologymentioning

confidence: 99%

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Diagnosis, treatment and prognosis of hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus (Review)

Xia

Zhang

2020

Oncol Lett

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Although tumor thrombus (TT) infringement of the inferior vena cava (IVC) and right atrium (RA) is rarely observed in hepatocellular carcinoma (HCC), the prognosis for this condition is extremely poor, with a median survival time of several months, given that the condition is often diagnosed at an advanced tumor stage or combined with multiple systemic metastases. Furthermore, there is no established effective treatment for the condition. However, some investigators insist that active treatment, including surgery, chemotherapy (systemic or intra-arterial), radiation therapy, best supportive care or a combination of these, may help prolong overall survival time in these patients. The management of patients with advanced HCC and a TT extending into the RA and IVC is extremely difficult and risky. To this end, the present review assessed the literature on the clinical features and treatments of this condition in recent years, with the aim of providing assistance for clinical work.

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Imaging findings and transcatheter arterial chemoembolization of hepatic malignancy with right atrial embolus in 46 patients

Cited by 8 publications

References 11 publications

Hepatocellular carcinoma with right atrial tumor thrombus: Report of a case

Hepatocellular carcinoma with right atrial tumor thrombus: Report of a case

Effective hepatic artery chemoembolization for advanced hepatocellular carcinoma with multiple tumor thrombi and pulmonary metastases: A case report

Diagnosis, treatment and prognosis of hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus (Review)

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