Combined treatment of hepatocellular carcinoma with partial splenic embolization and transcatheter hepatic arterial chemoembolization

Abstract

Aim: To prospectively evaluate the efficacy and safety of partial splenic embolization (PSE) combined with transcatheter hepatic arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma (HCC).

Methods: Fifty patients suffering from primary HCC associated with hypersplenism caused by cirrhosis were randomly assigned to 2 groups: group A receiving PSE combined with TACE (n = 26) and group B receiving TACE alone (n = 24). Follow-up examinations included calculation of peripheral blood cells (leukcytes, platelets and red blood cells) and treatment-associated complications.

Results: Prior to treatment, there was no significant difference in sex, age, Child-Pugh grade, tumor diameter, mass pathology type and peripheral blood cell counts between the 2 groups. After treatment, leukocyte and platelet counts were significantly higher in group A during the 3-mo follow-up period (P < 0.05), but lower in group B (P < 0.05). Severe complications occurred in 3 patients (11.5%) of group A and in 19 patients (79.2%) of group B (P < 0.05), and there was no significant difference in symptoms of post-embolization syndrome, including abdominal pain, fever, mild nausea and vomiting between the 2 groups (P > 0.05).

Conclusion: PSE combined with TACE is more effective and safe than TACE alone for patients with HCC associated with hypersplenism caused by cirrhosis.

Figure 1

PSE treatment for a 68-year-old male case of HCC with splenomegaly and thrombocytopenia. A: Splenic arteriography before PSE showing the whole splenic parnchymal image; B: Splenic arteriography after PSE showing the residual splenic parnchymal image, part of the peripheral splenic parenchyma was ablated, and the extent of embolization was roughly estimated of approximately 60%; C: Celiac arteriography before TACE showing the tumor blood-supply image; D: TACE is terminated when the tumor is filled with emulsifier; E: Transverse CT image revealing splenomegaly at 1 wk before PSE/TACE; F: Transverse CT image revealing the infarction of peripheral splenic parenchyma at 2 wk after PSE. The extent of embolization was 62% calculated by CT volume analysis software.