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. 2018 Jan 29;18(1):101.
doi: 10.1186/s12885-018-3989-2.

Intra-arterial ethanol embolization augments response to TACE for treatment of HCC with portal venous tumor thrombus

Biao Yang  1 , Chun-Lin Li  1 , Wen-Hao Guo  1 , Tian-Qiang Qin  2 , He Jiao  3 , Ze-Jun Fei  3 , Xuan Zhou  3 , Lin-Jia Duan  3 , Zheng-Yin Liao  4
Affiliations

Intra-arterial ethanol embolization augments response to TACE for treatment of HCC with portal venous tumor thrombus

Biao Yang et al. BMC Cancer. .

Abstract

Background: The prognosis of hepatocellular carcinoma with portal vein tumor thrombus remains extremely poor. This pilot study aimed to evaluate the technical feasibility, effectiveness and safety of transcatheter chemoembolization for tumors in the liver parenchyma plus intra-arterial ethanol embolization for portal vein tumor thrombus.

Methods: A pilot study was carried out on 31 patients in the treatment group (transcatheter chemoembolization plus intra-arterial ethanol embolization) and 57 patients in the control group (transcatheter chemoembolization alone). Enhanced computed tomography/magnetic resonance images were repeated 4 weeks after the procedure to assess the response. Overall survival and complications were assessed until the patient died or was lost to follow-up.

Results: Median survival was 10.5 months in the treatment group (2.4 ± 1.7 courses) and 3.9 months in the control group (1.9 ± 1 courses) (P = 0.001). Patients in the treatment group had better overall survival (at 3, 6 and 12 months, respectively), compared to patients in the control group (90.3% vs. 59.6%, 64.5% vs. 29.8%, and 41.9% vs. 10.6%; p = 0.001). Furthermore, the rate of portal vein tumor thrombus regression was higher in the treatment group (93.1%) than in the control group (32.1%) (P < 0.001).

Conclusions: Based on the results of this study, transcatheter chemoembolization combined with intra-arterial ethanol embolization may be more effective than transcatheter chemoembolization alone for treating hepatocellular carcinoma with portal vein tumor thrombus. Intra-arterial ethanol embolization for treating portal vein tumor thrombus is safe, feasible and prolongs overall survival.

Keywords: Cone-beam computed tomography; Hepatocellular carcinoma; Portal vein tumor thrombus; Transcatheter arterial chemoembolization.

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Conflict of interest statement

Ethics approval and consent to participate

This cohort study was approved by the Local Ethics Committee of West China Hospital, Sichuan University.

Consent for publication

Written informed consent was obtained from each patient after being informed of the purpose and investigational nature of this study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Intra-arterial ethanol embolization procedure for different types of PVTT. (A1) A microcatheter was inserted into place: (1) epirubicin injection followed by a gelatin sponge. (A2-A3) The microcatheter was withdrawn from its location: (2) lipiodol-ethanol mixture injection (1 ml/s), followed by a gelatin sponge. (B1) Same method as described in A1. (B2) A microcatheter was placed to permit the gelatin sponge to block the draining vessel. (B3) Lipiodol-ethanol mixture injection followed by gelatin sponge is shown
Fig. 3
Fig. 3
Intraarterial ethanol embolization with TACE in a 64-year-old male with HCC and PVTT (Vp3). (A1, A2) CT scan in the portal venous phase highlighting PVTT in the right portal vein (arrow) is shown; (A3) PVTT-feeding artery identified on CT. (B1) PVTT-feeding artery identified on DSA by superselective catheterization of the feeding artery using a microcatheter; (B2, B3) enhanced C-arm CT was performed to further confirm the PVTT-feeding artery; (C1-C3) axial CT showing lipiodol-ethanol mixture deposition within PVTT. (D1-D3) Follow-up images showing stable lipiodol-ethanol mixture deposition within PVTT at 3, 6, and 12 months after the operation
Fig. 4
Fig. 4
A graphical representation of the overall survival of patients in the two groups by the Kaplan-Meier method. a The total overall survival curve in the two groups. b The overall survival of patients diagnosed with Vp3 in the two groups. c The overall survival of patients with Vp4 in the two groups
See this image and copyright information in PMC

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