Hepatocellular carcinoma and portal vein invasion: results of treatment with transcatheter oily chemoembolization

Abstract

Objective: Our objective was to evaluate the efficacy and safety of transcatheter oily chemoembolization therapy in a series of patients with hepatocellular carcinoma and portal vein invasion.

Materials and methods: We retrospectively analyzed the results of transcatheter oily chemoembolization for 110 patients with hepatocellular carcinoma invading major portal branches. The Child's classes were A for 94 patients and B for 16. The main portal vein was partially (n = 33) or completely (n = 15) invaded in 48 patients, the right portal vein was invaded in 36, and the left portal vein was invaded in 26. Oily chemoembolization was performed with an emulsion of iodized oil and doxorubicin hydrochloride. Gelatin sponge particle embolization was added for 78 patients. Seventy-one patients underwent multiple treatment sessions.

Results: Our initial findings showed that 31 patients had complete or partial remission, with an overall median survival time of 6 months. The cumulative survival rates were 48% (6 months), 30% (1 year), 18% (2 years), and 9% (3 years). The parenchymal tumor extent was the most significant predicting factor for complications and efficacy of therapy. Of 33 patients with a parenchymal tumor limited to one or two segments of a hepatic lobe, 22 had complete or partial remission, with a median survival time of 22 months; this survival time was significantly longer than that (5 months) for 77 patients with a more extensive tumor (p < .0001). Hepatic insufficiency developed in 10 patients, and three of them died within 1 month after chemoembolization. All 10 patients had an extensive parenchymal tumor involving more than two hepatic segments, and four had impaired hepatic functional reserve of Child's class B.

Conclusion: When a tumor is limited in extent and hepatic function is preserved, transcatheter oily chemoembolization is effective and safe for the palliation of hepatocellular carcinoma and major portal vein invasion. However, when a parenchymal tumor is extensive, chemoembolization is associated with a poor response and a risk of hepatic failure.