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Tumor Response to Transcatheter Arterial Chemoembolization in Recurrent Hepatocellular Carcinoma after Living Donor Liver Transplantation

Ko HK, Ko GY, Yoon HK, Sung KB - Korean J Radiol (2007 Jul-Aug)

Bottom Line: The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients.There were no significant complications related to TACE.However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

Affiliation: Department of Radiology, Severance Hospital, University of Yonsei College of Medicine, Seoul 120-752, Korea. kbsung@amc.seoul.kr

ABSTRACT

Objective: To evaluate the tumor response and patient survival rate following transcatheter arterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (r-HCC) after living donor liver transplantation (LDLT).

Materials and methods: Twenty-eight patients with r-HCC underwent one or more cycles of TACE after LDLT (mean, 2.5 cycles). After a mixture of iodized oil and anti-cancer drugs was injected via the arteries feeding the tumors, these vessels were embolized with a gelatin sponge. Tumor response was determined by follow-up CT imaging on all patients four weeks after each TACE procedure. Patient survival was calculated using the Kaplan-Meier survival curve.

Results: After TACE, targeted tumor reduced in size by 25% or more in 19 of the 28 study patients (67.9%). However, intrahepatic recurrence or extrahepatic metastasis occurred in 21 of the 28 patients (75.0%) during the 3-month follow-up period and in 26 of the 28 patients (92.9%) during the 6-month period following TACE. Extrahepatic metastasis was noted in 18 of the 28 patients (64.3%). The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients. There were no significant complications related to TACE.

Conclusion: TACE produces an effective tumor response for targeted r-HCC after LDLT. However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

A.Contrast-enhanced arterial-phase axial CT image of the liver 17 months after living donor liver transplantation shows the single arterial enhancing mass (arrow) in the posterior portion of the transplanted liver.B.Arteriogram from the celiac trunk (late arterial phase) shows an area of tumor blush in the transplanted liver (arrow).C.Arteriogram from the celiac trunk immediately after embolization shows that the tumor blush has disappeared.D.Contrast-enhanced arterial-phase axial CT image of the liver one month after transcatheter arterial chemoembolization reveals complete iodized oil accumulation (arrow) in the tumor. We interpreted this patient as having CR.E.Contrast-enhanced arterial-phase axial CT image of the liver 22 months after transcatheter arterial chemoembolization shows a decrease in the size of the recurrent hepatocellular carcinoma with iodized oil accumulation.
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Figure 1: A.Contrast-enhanced arterial-phase axial CT image of the liver 17 months after living donor liver transplantation shows the single arterial enhancing mass (arrow) in the posterior portion of the transplanted liver.B.Arteriogram from the celiac trunk (late arterial phase) shows an area of tumor blush in the transplanted liver (arrow).C.Arteriogram from the celiac trunk immediately after embolization shows that the tumor blush has disappeared.D.Contrast-enhanced arterial-phase axial CT image of the liver one month after transcatheter arterial chemoembolization reveals complete iodized oil accumulation (arrow) in the tumor. We interpreted this patient as having CR.E.Contrast-enhanced arterial-phase axial CT image of the liver 22 months after transcatheter arterial chemoembolization shows a decrease in the size of the recurrent hepatocellular carcinoma with iodized oil accumulation.

Mentions: The characteristics of r-HCC are summarized in Table 2. The median time from liver transplantation to detection of r-HCC was 15 months (range, 2-57 months). TACE was performed within one year, between one and three years, between two and three years, or more than three years after LDLT in 16 (57.1%), seven (25.0%), four (14.3%), or one (3.6%) patient, respectively. Nine of 26 patients with intrahepatic recurrence had solitary nodular r-HCC (Fig. 1), while the remaining 17 patients had multiple r-HCC (Fig. 2). Eighteen study patients (64.3%) were initially diagnosed with r-HCC extrahepatic metastasis, of which lung metastasis was the most common followed by bone and peritoneal metastases (Table 2). AFP values were greater than 400 ng/ml in 18 of 28 patients (64.3%).

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Tumor Response to Transcatheter Arterial Chemoembolization in Recurrent Hepatocellular Carcinoma after Living Donor Liver Transplantation

Ko HK, Ko GY, Yoon HK, Sung KB - Korean J Radiol (2007 Jul-Aug)

A.Contrast-enhanced arterial-phase axial CT image of the liver 17 months after living donor liver transplantation shows the single arterial enhancing mass (arrow) in the posterior portion of the transplanted liver.B.Arteriogram from the celiac trunk (late arterial phase) shows an area of tumor blush in the transplanted liver (arrow).C.Arteriogram from the celiac trunk immediately after embolization shows that the tumor blush has disappeared.D.Contrast-enhanced arterial-phase axial CT image of the liver one month after transcatheter arterial chemoembolization reveals complete iodized oil accumulation (arrow) in the tumor. We interpreted this patient as having CR.E.Contrast-enhanced arterial-phase axial CT image of the liver 22 months after transcatheter arterial chemoembolization shows a decrease in the size of the recurrent hepatocellular carcinoma with iodized oil accumulation.
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Figure 1: A.Contrast-enhanced arterial-phase axial CT image of the liver 17 months after living donor liver transplantation shows the single arterial enhancing mass (arrow) in the posterior portion of the transplanted liver.B.Arteriogram from the celiac trunk (late arterial phase) shows an area of tumor blush in the transplanted liver (arrow).C.Arteriogram from the celiac trunk immediately after embolization shows that the tumor blush has disappeared.D.Contrast-enhanced arterial-phase axial CT image of the liver one month after transcatheter arterial chemoembolization reveals complete iodized oil accumulation (arrow) in the tumor. We interpreted this patient as having CR.E.Contrast-enhanced arterial-phase axial CT image of the liver 22 months after transcatheter arterial chemoembolization shows a decrease in the size of the recurrent hepatocellular carcinoma with iodized oil accumulation.
Mentions: The characteristics of r-HCC are summarized in Table 2. The median time from liver transplantation to detection of r-HCC was 15 months (range, 2-57 months). TACE was performed within one year, between one and three years, between two and three years, or more than three years after LDLT in 16 (57.1%), seven (25.0%), four (14.3%), or one (3.6%) patient, respectively. Nine of 26 patients with intrahepatic recurrence had solitary nodular r-HCC (Fig. 1), while the remaining 17 patients had multiple r-HCC (Fig. 2). Eighteen study patients (64.3%) were initially diagnosed with r-HCC extrahepatic metastasis, of which lung metastasis was the most common followed by bone and peritoneal metastases (Table 2). AFP values were greater than 400 ng/ml in 18 of 28 patients (64.3%).

Bottom Line: The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients.There were no significant complications related to TACE.However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

Affiliation: Department of Radiology, Severance Hospital, University of Yonsei College of Medicine, Seoul 120-752, Korea. kbsung@amc.seoul.kr

ABSTRACT

Background:

Objective: To evaluate the tumor response and patient survival rate following transcatheter arterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (r-HCC) after living donor liver transplantation (LDLT).

Materials and methods: Twenty-eight patients with r-HCC underwent one or more cycles of TACE after LDLT (mean, 2.5 cycles). After a mixture of iodized oil and anti-cancer drugs was injected via the arteries feeding the tumors, these vessels were embolized with a gelatin sponge. Tumor response was determined by follow-up CT imaging on all patients four weeks after each TACE procedure. Patient survival was calculated using the Kaplan-Meier survival curve.

Results: After TACE, targeted tumor reduced in size by 25% or more in 19 of the 28 study patients (67.9%). However, intrahepatic recurrence or extrahepatic metastasis occurred in 21 of the 28 patients (75.0%) during the 3-month follow-up period and in 26 of the 28 patients (92.9%) during the 6-month period following TACE. Extrahepatic metastasis was noted in 18 of the 28 patients (64.3%). The 1-, 3- and 5-year survival rates following TACE were 47.9, 6.0 and 0%, respectively, with a mean survival of nine months in all patients. There were no significant complications related to TACE.

Conclusion: TACE produces an effective tumor response for targeted r-HCC after LDLT. However, the survival rate of patients with r-HCC after LDLT is poor due to extrahepatic metastasis and intrahepatic recurrence.

View Similar Images In: Results  - Collection
View Article: Medline Plus - Pubmed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2627154&rFormat=json&query=null&req=5