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. 2009 Jun;135(6):783-9.
doi: 10.1007/s00432-008-0513-0. Epub 2008 Nov 26.

Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation

Zheng-Hua Lu  1 , Feng Shen, Zhen-Lin Yan, Jun Li, Jia-He Yang, Ming Zong, Le-Hua Shi, Meng-Chao Wu
Affiliations

Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation

Zheng-Hua Lu et al. J Cancer Res Clin Oncol. 2009 Jun.

Abstract

Background: Portal vein tumor thrombus (PVTT) is a common complication of hepatocellular carcinoma (HCC), and is associated with extremely poor prognosis.

Patients and methods: In this retrospective study, we first evaluate the application of percutaneous laser ablation as a treatment for PVTT due to advanced hepatocellular carcinoma. 108 patients (2002.7-2005.12) that have adequate liver function and be in reasonably good general condition were enrolled at Eastern hepatobiliary surgery hospital. The thrombus was ablated via an optic fiber placed in the guide needle with the guiding of ultrasound. In the follow-ups, the serial imaging and laboratory routines were examined and the overall clinical progress was measured at regular intervals until time of death. In the clinical assessment, survival time and factors affecting survival time were analyzed. The changes of laboratory test (alanine transaminase and alpha fetoprotein) and clinical manifestation (ascites and diarrhea) of the PVTT patients before and after laser ablation were observed.

Results: Patency of the tumor-occluded portal vein branch is the only factor that affect the survival time, the longer the patency time, the longer the survival time. The long-term survivals of patients in our study are 55.56, 33.58 and 22.38% at 1, 2 and 3 years, respectively. Both laboratory test and clinical presentations were improved. Alphalpha fetoprotein in the positive patients decreased and alanine transaminase in the abnormal patients normalized at 1 month after the treatment. Ascites disappeared in 44.00% patients (11/25), and diarrhea ameliorated in 57.14% (12/21).

Conclusion: Laser ablation might be a novel and effective treatment for PVTT associated with advanced HCC.

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Figures

Fig. 1
Fig. 1
Case 1, HCC patient, male, 50 years old, underwent TACE on 9 September 2003, laser ablation on 16 September 2003. a CT scan before laser ablation on 14 September 2003, Portal vein tumor thrombus (PVTT) in the right branch. b CT scan after laser ablation on 5 December 2005. PVTT in the right branch disappeared
Fig. 2
Fig. 2
Case 2, HCC patient, female, 49 years old, underwent TACE on 27 June 2003 and received laser ablation on 8 August 2003. a the CT scan of the PVTT in the left branch before laser ablation on 29 July 2003. b CT scan after treatment on 26 March 2007. The left branch of portal vein changed into honey-comb like appearance. c Doppler manifestation before laser ablation on 8 August. No blood flow was detected in the portal vein. d Doppler manifestation after laser ablation on 5 January 2006. Blood flow in the portal vein after laser ablation. Arrow showed the blood flow in portal vein
See this image and copyright information in PMC

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