Partial Splenic Embolization with Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma Accompanied by Thrombocytopenia

Abstract

Background. Thrombocytopenia often makes the introduction of systemic treatment difficult in patients with cirrhosis and hepatocellular carcinoma (HCC). We retrospectively evaluated the long-term effects of partial splenic embolization (PSE) with transarterial chemoembolization (TACE) in patients with HCC patients accompanied by thrombocytopenia. Patients and Methods. Twenty-one patients with HCC complicated by severe thrombocytopenia (platelet count, <5.0 × 104/mm3) were treated with PSE and TACE. Both the safety and platelet-increasing effect was evaluated in these patients. Results. Seventeen of 21 patients (81.0%) showed increased platelet counts to ≥5.0 × 104/mm3. Subsequently, 13 patients (61.9%) successfully received systemic chemotherapy. Platelet counts and serum levels of total bilirubin, as well as neutrophil counts, improved significantly one month after treatment. However, serum levels of albumin and hemoglobin decreased significantly one month after treatment. Severe adverse events, including acute liver failure and portal vein thrombus, were observed in two patients. Conclusion. PSE with selective TACE made it possible for patients with HCC and severe thrombocytopenia to receive systemic chemotherapy. Although PSE with TACE was safe and tolerable for most patients, the extent of PSE with TACE in a wide area of the liver may increase the risk for fatal liver failure.

Long-Term Efficacy and Safety of Partial Splenic Embolization in Hepatocellular Carcinoma Patients with Thrombocytopenia Who Underwent Transarterial Chemoembolization

“…Several studies have reported the positive results on the efficacy of PSE for HCC patients with thrombocytopenia caused by liver cirrhosis and supported its use in the treatment of hypersplenism, which is consistent with our results 15232430. One prospective study from China, including 50 HCC patients with hypersplenism caused by cirrhosis, showed that platelet and leukocyte counts after combined one-step TACE/PSE treatment were significantly higher compared with baseline during the three-month follow-up period ( P < 0.001), whereas those after TACE alone were significantly lower compared with baseline ( P < 0.001) 15.…”

“…It may enable HCC patients with severe thrombocytopenia related to splenomegaly to undergo TACE procedures. Although several studies have reported the positive clinical results of combination therapy with PSE and TACE for HCC patients with severe thrombocytopenia, to the best of our knowledge, the long-term clinical results of more than 1 year of PSE treatment combined with TACE in HCC patients with severe thrombocytopenia have not been reported 152324. Therefore, the current study aimed to evaluate the long-term efficacy and safety of PSE combined with TACE in HCC patients with severe thrombocytopenia.…”

Perioperative safety analysis of transcatheter arterial chemoembolization for hepatocellular carcinoma patients with preprocedural leukopenia or thrombocytopenia

“…TACE is a minimally invasive operation; thus, there is no strict requirement in terms of a preprocedural PLT count. For HCC patients with a low PLT count, TACE is feasible if PLT transfusion is performed prior to the procedure (13,23). A previous study investigated partial splenic embolization in cirrhosis patients with reduced PLT counts, and reported no complications such as puncture site bleeding or skin/mucosal bleeding, whereas the PLT/WBC counts increased significantly following treatment (23).…”

“…A previous study investigated partial splenic embolization in cirrhosis patients with reduced PLT counts, and reported no complications such as puncture site bleeding or skin/mucosal bleeding, whereas the PLT/WBC counts increased significantly following treatment (23). Ooka et al (13) performed TACE (n=32) and partial splenic embolization (PSE; n=32) simultaneously in 21 HCC patients with reduced PLT counts (24-49x10 9 /l). That study reported that, following TACE, the PLT count increased to >50x10 9 /l in 17 of the 21 patients, of whom 13 received systemic chemotherapy, and 2 of the 21 patients developed hematomas (6%).…”

“…In our clinical practice, TACE is considered to be relatively safe for HCC patients with WBC or PLT counts below these thresholds, and such patients do not commonly experience severe infection, bleeding, agranulocytosis, or thrombocytopenia following TACE. Ooka et al (13) also performed TACE safely in HCC patients with reduced preprocedural PLT counts. The required WBC and PLT counts for administration of TACE to HCC patients with cirrhosis differ among countries (12,(14)(15)(16), with some countries not even taking WBC or PLT counts into consideration (14)(15)(16).…”