Imaging Diagnosis and Interventional Treatment for Hepatocellular Carcinoma Combined with Arteriovenous Fistula

In order to explore the imaging diagnosis methods and interventional treatment effects of hepatocellular carcinoma combined with hepatic arteriovenous fistula (HAVF), a total of 120 patients, who were diagnosed as hepatic carcinoma with arteriovenous shunting and underwent medical imaging diagnosis and interventional surgery therapy at a designated hospital by this study from December 2014 to December 2018, were chosen as study subjects. Digital subtraction angiography was performed to analyze the imaging features of hepatocellular carcinoma combined with HAVF in each patient; then, according to these imaging diagnosis results, gelatin sponge or coil was used to block the fistula; mitomycin, carboplatin powder, and lipiodol mixed emulsion was combined or separately utilized for hepatic tumor embolization, in which iodized oil embolization chemotherapy was used for patients with mild paralysis; gelatin sponge granule embolization chemotherapy was used for moderate paralysis patients at their first intervention, and, after about 1 month, if the sputum disappeared, iodized oil embolization was used again; and hepatic arterial infusion chemotherapy was used only for patients with severe paralysis. The results show that the central type of HAVF is characterized by early angiography of portal vein and large branches and tumor staining after portal vein’s angiography; the peripheral type of HAVF is characterized by portal vein branching in hepatic tumor and double rail sign accompanied by the arterial branch; 112 cases of patients completed embolization chemotherapy; 8 cases of patients only received chemotherapy perfusion; in 109 cases of patients sputum disappeared or shunt decreased at first treatment; and in 113 cases of patients iodine oil was well deposited or the tumor was stably reduced; most of the symptoms of refractory ascites, diarrhea, and upper gastrointestinal bleeding were controlled or improved, and there were no complications such as pulmonary embolism and hepatic failure. Therefore, HAVF increases the difficulty of interventional therapy, but, as long as the positive and appropriate treatment measures are taken, it can still achieve better curative effect without serious complications, which can effectively alleviate the clinical symptoms of patients and improve the quality of life of patients. The results of this study provide a reference for the further researches on imaging diagnosis and interventional treatment for hepatocellular carcinoma combined with arteriovenous fistula.

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Predictive factors of transcatheter arterial chemoembolization for hepatocellular carcinoma

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4541 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4541-4541

Author(s):

H. Ishii ◽

J. Furuse ◽

K. Nakachi ◽

E. Suzuki ◽

S. Shimizu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Predictive Factors ◽

Transcatheter Arterial Chemoembolization ◽

Objective Response ◽

Gelatin Sponge ◽

Iodized Oil ◽

Multiple Tumors ◽

Multiple Tumor ◽

Solitary Tumor ◽

Arterial Chemoembolization

4541 Background/Aim: Although transcatheter arterial chemoembolization (TACE) has been widely used for the treatment of unresectable hepatocellular carcinoma (HCC), the optimal indication of the TACE has not been fully elucidated. Methods: The treatment outcomes after TACE were analyzed retrospectively to determine predictive factors of anti-cancer effect on HCC. The patient (pts) selection criteria were: 1) admission between 1992 and 2005, 2) diagnosis of fresh HCC, 3) no extrahepatic metastasis and 4) primary treatment with TACE. TACE was performed by selectively introducing a catheter into the hepatic artery and injecting gelatin sponge particles following an emulsion consisting of 2–5 ml of iodized oil (Lipiodol) and 20–50 mg doxorubicin hydrochloride. Lipiodol accumulation in tumors was regarded as an indication of necrosis. We defined complete response (CR) as disappearance or 100% necrosis of all tumors, and partial response (PR) as more than 50% reduction and/or more than 50% necrosis. Results: There were 270 pts who fulfilled the above criteria. According to Japan Integrated Staging, the number of T1, T2, T3 and T4 was 10, 59, 171 and 30, respectively. There were 52 CRs, 113 PRs, 77 who remained SD and 28 who showed PD/NE. The median survival months of CR, PR, SD and PD/NE were 50, 30, 15 and 5, respectively, and there was a significant differences between them. The logistic regression analysis revealed tumor multiplicity and vascular invasion (VI) were significantly associated with the objective response (CR or PR). The response probability of patients with solitary tumor without VI was 85%, that with multiple tumors without VI was 63%, that with solitary tumor with VI was 33% and that with multiple tumors with VI was 16%. The small tumor (<5 cm) was another favorable factor which was significantly associated with CR. Among 231 patients without VI, the CR probability of patients with a solitary tumor <5 cm or >5 cm was 46% or 40%, respectively; although that of those with multiple tumors <5cm or >5cm was 21% or 5%, respectively. Conclusion: TACE is recommended for HCC patients without VI, and is optimally indicated for those with a solitary tumor or those with multiple tumor <5 cm among them. No significant financial relationships to disclose.

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Preoperative portal vein embolization with a mixture of gelatin sponge and iodized oil: efficacy and safety

Acta Radiologica ◽

10.1080/02841850600979063 ◽

2006 ◽

Vol 47 (10) ◽

pp. 1022-1028 ◽

Cited By ~ 12

Author(s):

H. Kakizawa ◽

N. Toyota ◽

K. Arihiro ◽

A. Naito ◽

Y. Fujimura ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Gelatin Sponge ◽

Efficacy And Safety ◽

Iodized Oil

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Treatment Strategy of Transarterial Chemoembolization for Hepatocellular Carcinoma

Applied Sciences ◽

10.3390/app10207337 ◽

2020 ◽

Vol 10 (20) ◽

pp. 7337

Author(s):

Shiro Miyayama

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Cancer ◽

Transarterial Chemoembolization ◽

Liver Toxicity ◽

Primary Liver Cancer ◽

Controlled Trial ◽

Sequential Therapy ◽

Asia Pacific ◽

Gelatin Sponge ◽

Iodized Oil

Transarterial chemoembolization (TACE) is a first-line treatment for patients with hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer stage B (BCLC-B). There are two major techniques of TACE: conventional TACE (cTACE) using iodized oil and gelatin sponge particles, and TACE using drug-eluting beads (DEB-TACE). The latest randomized controlled trial proved the superiority of cTACE regarding local effects over DEB-TACE; however, cTACE also damages the liver more severely. Therefore, cTACE should be performed for localized HCCs as selectively as possible. On the other hand, DEB-TACE has less liver toxicity and is favorable for patients with an advanced age, large and/or bilobar tumors, or a poor liver function. However, some BCLC-B HCCs are TACE-resistant and the concept of TACE unsuitability (mainly up-to-7 criteria out) has been proposed by Asia-Pacific Primary Liver Cancer Expert Meeting. Systemic therapy is recommended for patients with TACE-unsuitable HCC; however, the condition of TACE-unsuitable HCC does not always rule out TACE monotherapy and some up-to-7 criteria out tumors may also be good candidates for superselective cTACE when localized in limited liver segments. The sequential therapy of an antiangiogenic and TACE is also a novel option for patients with TACE-unsuitable HCC, antiangiogenic-refractory HCC, or even down-staged HCC.

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Portal Vein Stenting Combined with 125I Particle Chain Implantation Followed by As2O3 in the Treatment of Hepatocellular Carcinoma with Portal Vein Tumour Thrombus

BioMed Research International ◽

10.1155/2020/4109216 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Zhaonan Li ◽

Guangyan Si ◽

De-Chao Jiao ◽

Xinwei Han ◽

Wenguang Zhang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Adverse Events ◽

Portal Vein ◽

Interventional Treatment ◽

Treatment Needs ◽

Stent Patency ◽

Cumulative Survival ◽

Tumour Thrombus ◽

Particle Chain ◽

Portal Vein Tumour Thrombus

Objective. To evaluate the feasibility and safety of portal vein stenting (PVS) combined with 125I particle chain implantation and sequential arsenic trioxide (As2O3) for the treatment of hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) by transcatheter arterial chemoembolization (TACE). Methods. From January 2015 to January 2018, the clinical data of 30 patients with HCC complicated by PVTT were retrospectively analysed (26 men and 4 women). The laboratory examinations, incidence of adverse events, cumulative survival rate, and stent patency were analysed for all enrolled patients. Results. The success rate of interventional treatment in all patients was 100%. The results of the laboratory tests before and 1 week after surgery showed that the mean concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) decreased from 50.9 U/L ± 25.8 to 41.8 U/L ± 21.6 (P<0.001) and 57.6 U/L ± 19.9 to 44.2 U/L ± 26.1 (P<0.001), respectively. No complications in grade 3 or higher according to the Common Terminology Criteria for Adverse Events (CTCAE) were observed. The cumulative survival rates at 3, 6, 9, and 12 months were 83.1%, 69.2%, 43.7%, and 31.2%, respectively, while the patency rates of the stents were 83.3%, 80.0%, 52.2%, and 38.3%, respectively. Of the 30 deaths during the follow-up period, 16 patients died of liver failure, 8 died of gastrointestinal bleeding, 3 died of lung metastasis, 2 died of brain metastases, and 1 died of heart failure because the tumour invaded the atria. Conclusion. PVS combined with 125I particle chain implantation followed by TACE with As2O3 is safe and feasible for patients with PVTT. The long-term efficacy of this treatment needs to be further studied.

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