Portal Vein Embolization: Impact of Chemotherapy and Genetic Mutations

Amy R Deipolyi¹, Yu Shrike Zhang^{2

3

4}, Ali Khademhosseini^{5

6

7}, Sailendra Naidu⁸, Mitesh Borad⁹, Burcu Sahin¹⁰, Amit K Mathur¹¹, Rahmi Oklu^{12

13}

Affiliations

¹ Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA. deipolya@mskcc.org.
² Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. yszhang@mit.edu.
³ Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA. yszhang@mit.edu.
⁴ Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA. yszhang@mit.edu.
⁵ Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. alik@bwh.harvard.edu.
⁶ Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA. alik@bwh.harvard.edu.
⁷ Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA. alik@bwh.harvard.edu.
⁸ Division of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA. naidu.sailen@mayo.edu.
⁹ Division of Oncology, Mayo Clinic, Phoenix, AZ 85054, USA. borad.mitesh@mayo.edu.
¹⁰ Department of Radiology, Ankara Oncology Training and Research Hospital, Ankara, Turkey. bsavrans@gmail.com.
¹¹ Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ 85054, USA. mathur.amit@mayo.edu.
¹² Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. oklu.rahmi@mayo.edu.
¹³ Division of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA. oklu.rahmi@mayo.edu.

PMID: 28257031
PMCID: PMC5372995
DOI: 10.3390/jcm6030026

Portal Vein Embolization: Impact of Chemotherapy and Genetic Mutations

Amy R Deipolyi et al. J Clin Med. 2017.

. 2017 Mar 1;6(3):26.

doi: 10.3390/jcm6030026.

Authors

Amy R Deipolyi¹, Yu Shrike Zhang^{2

3

4}, Ali Khademhosseini^{5

6

7}, Sailendra Naidu⁸, Mitesh Borad⁹, Burcu Sahin¹⁰, Amit K Mathur¹¹, Rahmi Oklu^{12

13}

Affiliations

¹ Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA. deipolya@mskcc.org.
² Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. yszhang@mit.edu.
³ Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA. yszhang@mit.edu.
⁴ Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA. yszhang@mit.edu.
⁵ Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. alik@bwh.harvard.edu.
⁶ Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA. alik@bwh.harvard.edu.
⁷ Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA. alik@bwh.harvard.edu.
⁸ Division of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA. naidu.sailen@mayo.edu.
⁹ Division of Oncology, Mayo Clinic, Phoenix, AZ 85054, USA. borad.mitesh@mayo.edu.
¹⁰ Department of Radiology, Ankara Oncology Training and Research Hospital, Ankara, Turkey. bsavrans@gmail.com.
¹¹ Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ 85054, USA. mathur.amit@mayo.edu.
¹² Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. oklu.rahmi@mayo.edu.
¹³ Division of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA. oklu.rahmi@mayo.edu.

PMID: 28257031
PMCID: PMC5372995
DOI: 10.3390/jcm6030026

Abstract

We characterized the effect of systemic therapy given after portal vein embolization (PVE) and before hepatectomy on hepatic tumor and functional liver remnant (FLR) volumes. All 76 patients who underwent right PVE from 2002-2016 were retrospectively studied. Etiologies included colorectal cancer (n = 44), hepatocellular carcinoma (n = 17), cholangiocarcinoma (n = 10), and other metastases (n = 5). Imaging before and after PVE was assessed. Chart review revealed systemic therapy administration, SNaPshot genetic profiling, and comorbidities. Nine patients received systemic therapy; 67 did not. Tumor volume increased 28% in patients who did not receive and decreased -24% in patients who did receive systemic therapy (p = 0.026), with no difference in FLR growth (28% vs. 34%; p = 0.645). Among 30 patients with genetic profiling, 15 were wild type and 15 had mutations. Mutations were an independent predictor of tumor growth (p = 0.049), but did not impact FLR growth (32% vs. 28%; p = 0.93). Neither cirrhosis, hepatic steatosis, nor diabetes impacted changes in tumor or FLR volume (p > 0.20). Systemic therapy administered after PVE before hepatic lobectomy had no effect on FLR growth; however, it was associated with decreasing tumor volumes. Continuing systemic therapy until hepatectomy may be warranted, particularly in patients with genetic mutations.

Keywords: angiography; chemotherapy; embolization; mutation; portal vein embolization.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
(A) Pre-procedure CT imaging demonstrates a right hepatic metastasis (arrow) from colorectal cancer, with a diminutive left lobe; (B) Tranhepatic portography (arrow) is obtained after portal access is achieved via the right portal vein; (C) The right portal branches have been embolized with particles and metallic coils (arrow); (D) 200× magnification H&E stain slide demonstrates Embosphere particles within a portal vein (arrow); (E) Gross specimen after right hepatectomy demonstrates particles within the embolized right hepatic lobe. White bar indicates 5 cm.

See this image and copyright information in PMC

References

1. Azoulay D., Castaing D., Smail A., Adam R., Cailliez V., Laurent A., Lemoine A., Bismuth H. Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann. Surg. 2000;231:480–486. doi: 10.1097/00000658-200004000-00005. - DOI - PMC - PubMed
1. Palavecino M., Chun Y.S., Madoff D.C., Zorzi D., Kishi Y., Kaseb A.O., Curley S.A., Abdalla E.K., Vauthey J.N. Major hepatic resection for hepatocellular carcinoma with or without portal vein embolization: Perioperative outcome and survival. Surgery. 2009;145:399–405. doi: 10.1016/j.surg.2008.10.009. - DOI - PubMed
1. Castellano E., Downward J. RAS Interaction with PI3K: More Than Just Another Effector Pathway. Genes Cancer. 2011;2:261–274. doi: 10.1177/1947601911408079. - DOI - PMC - PubMed
1. Courtney K.D., Corcoran R.B., Engelman J.A. The PI3K pathway as drug target in human cancer. J. Clin. Oncol. 2010;28:1075–1083. doi: 10.1200/JCO.2009.25.3641. - DOI - PMC - PubMed
1. Oklu R., Walker T.G., Wicky S., Hesketh R. Angiogenesis and current antiangiogenic strategies for the treatment of cancer. J. Vasc. Interv. Radiol. 2010;21:1791–1805. doi: 10.1016/j.jvir.2010.08.009. - DOI - PubMed

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Portal Vein Embolization: Impact of Chemotherapy and Genetic Mutations

Affiliations

Portal Vein Embolization: Impact of Chemotherapy and Genetic Mutations

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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