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The Safety and Clinical Outcomes of Chemoembolization in Child-Pugh Class C Patients with Hepatocellular Carcinomas.

Choi TW, Kim HC, Lee JH, Yu SJ, Kang B, Hur S, Lee M, Jae HJ, Chung JW - Korean J Radiol (2015)

Bottom Line: Major complications were observed in five (9.1%) patients who were all beyond the Milan criteria: two hepatic failures, one hepatic encephalopathy, and two CTCAE grade 3 increases in aspartate aminotransferase/alanine aminotransferase abnormality.The tumor responses of the patients who met the Milan criteria were significantly higher (p = 0.014) than those of the patients who did not.The overall median survival was 7.1 months (95% confidence interval: 4.4-9.8 months).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.

ABSTRACT

Objective: To evaluate the safety and clinical outcomes of chemoembolization in Child-Pugh class C patients with hepatocellular carcinomas (HCC).

Materials and methods: The study comprised 55 patients with HCC who were classified as Child-Pugh class C and who underwent initial chemoembolization between January 2003 and December 2012. Selective chemoembolization was performed in all technically feasible cases to minimize procedure-related complications. All adverse events within 30 days were recorded using the Common Terminology Criteria for Adverse Events (CTCAE). The tumor response to chemoembolization was evaluated using the modified Response Evaluation Criteria In Solid Tumors.

Results: Thirty (54.5%) patients were within the Milan criteria, and 25 (45.5%) were beyond. The mortality of study subjects at 30 days was 5.5%. Major complications were observed in five (9.1%) patients who were all beyond the Milan criteria: two hepatic failures, one hepatic encephalopathy, and two CTCAE grade 3 increases in aspartate aminotransferase/alanine aminotransferase abnormality. The mean length of hospitalization was 6.3 ± 8.3 days (standard deviation), and 18 (32.7%) patients were discharged on the next day after chemoembolization. The tumor responses of the patients who met the Milan criteria were significantly higher (p = 0.014) than those of the patients who did not. The overall median survival was 7.1 months (95% confidence interval: 4.4-9.8 months).

Conclusion: Even in patients with Child-Pugh class C, chemoembolization can be performed safely with a selective technique in selected cases with a small tumor burden.

No MeSH data available.


Related in: MedlinePlus

52-year-old woman with Child-Pugh class C liver cirrhosis.A. Axial CT image obtained at arterial phase shows 4.5 cm arterial enhancing mass (arrowheads) in segment 4 of liver. Note cirrhotic liver and large amount of ascites. B. Celiac arteriography shows hypervascular tumor staining (arrowhead) that is supplied by two prominent feeding arteries from left hepatic artery. C. Tip of microcatheter (arrowhead) was placed at distal portion of one of tumor-feeding arteries and followed by infusion of iodized oil emulsion. D. Thereafter, other tumor-feeding branch from left hepatic artery was selected and catheterized with microcatheter (arrowhead), and chemoembolization was performed. Spot image obtained during chemoembolization shows additional dense accumulation of iodized oil in tumor and oily portogram around tumor. E. Arterial phase image of follow-up liver CT scan shows dense accumulation of iodized oil in previously noted hepatocellular carcinoma in segment 4 (arrowheads) with no evidence of viable tumor.
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Figure 1: 52-year-old woman with Child-Pugh class C liver cirrhosis.A. Axial CT image obtained at arterial phase shows 4.5 cm arterial enhancing mass (arrowheads) in segment 4 of liver. Note cirrhotic liver and large amount of ascites. B. Celiac arteriography shows hypervascular tumor staining (arrowhead) that is supplied by two prominent feeding arteries from left hepatic artery. C. Tip of microcatheter (arrowhead) was placed at distal portion of one of tumor-feeding arteries and followed by infusion of iodized oil emulsion. D. Thereafter, other tumor-feeding branch from left hepatic artery was selected and catheterized with microcatheter (arrowhead), and chemoembolization was performed. Spot image obtained during chemoembolization shows additional dense accumulation of iodized oil in tumor and oily portogram around tumor. E. Arterial phase image of follow-up liver CT scan shows dense accumulation of iodized oil in previously noted hepatocellular carcinoma in segment 4 (arrowheads) with no evidence of viable tumor.

Mentions: All patients underwent contrast-enhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) within 40 days before the chemoembolization procedure. The methods and techniques of chemoembolization at our institution are summarized as follows: First, arteriography of the celiac and superior mesenteric arteries was performed with a 5-Fr angiographic catheter (RH catheter; Cook, Bloomington, IN, USA) to evaluate the anatomical variation of the hepatic arteries, the location and extent of the HCC, and the tumor-feeding arteries. Selective chemoembolization of the subsegmental hepatic artery was initially considered and performed in all technically feasible cases to minimize procedure-related complications such as hepatic function deterioration. After the microcatheter with a 2.0-Fr tip (Progreat; Terumo, Tokyo, Japan) or a 2.4-Fr tip (Microferret-18; Cook) was advanced into the most distal branches of the tumor-feeding artery that were technically accessible, an emulsion of iodized oil (Lipiodol; Laboratoire Andre Guerbet, Aulnay-sous-Bois, France) mixed with doxorubicin hydrochloride (Adriamycin RDF; Ildong, Seoul, Korea) was infused via the microcatheter until a decrease in the blood flow to the tumor was observed (Fig. 1). The mean dose of doxorubicin hydrochloride was 26.0 ± 12.1 mg, and the median dose was 30 mg. Additional embolization was performed with 1 mm-sized absorbable gelatin sponge particles (Gelform; Upjohn, Kalamanzoo, MI, USA or Cutanplast; Mascia Brunelli, Milan, Italy) to maximize the therapeutic effect of the chemoembolization.


The Safety and Clinical Outcomes of Chemoembolization in Child-Pugh Class C Patients with Hepatocellular Carcinomas.

Choi TW, Kim HC, Lee JH, Yu SJ, Kang B, Hur S, Lee M, Jae HJ, Chung JW - Korean J Radiol (2015)

52-year-old woman with Child-Pugh class C liver cirrhosis.A. Axial CT image obtained at arterial phase shows 4.5 cm arterial enhancing mass (arrowheads) in segment 4 of liver. Note cirrhotic liver and large amount of ascites. B. Celiac arteriography shows hypervascular tumor staining (arrowhead) that is supplied by two prominent feeding arteries from left hepatic artery. C. Tip of microcatheter (arrowhead) was placed at distal portion of one of tumor-feeding arteries and followed by infusion of iodized oil emulsion. D. Thereafter, other tumor-feeding branch from left hepatic artery was selected and catheterized with microcatheter (arrowhead), and chemoembolization was performed. Spot image obtained during chemoembolization shows additional dense accumulation of iodized oil in tumor and oily portogram around tumor. E. Arterial phase image of follow-up liver CT scan shows dense accumulation of iodized oil in previously noted hepatocellular carcinoma in segment 4 (arrowheads) with no evidence of viable tumor.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4644750&req=5

Figure 1: 52-year-old woman with Child-Pugh class C liver cirrhosis.A. Axial CT image obtained at arterial phase shows 4.5 cm arterial enhancing mass (arrowheads) in segment 4 of liver. Note cirrhotic liver and large amount of ascites. B. Celiac arteriography shows hypervascular tumor staining (arrowhead) that is supplied by two prominent feeding arteries from left hepatic artery. C. Tip of microcatheter (arrowhead) was placed at distal portion of one of tumor-feeding arteries and followed by infusion of iodized oil emulsion. D. Thereafter, other tumor-feeding branch from left hepatic artery was selected and catheterized with microcatheter (arrowhead), and chemoembolization was performed. Spot image obtained during chemoembolization shows additional dense accumulation of iodized oil in tumor and oily portogram around tumor. E. Arterial phase image of follow-up liver CT scan shows dense accumulation of iodized oil in previously noted hepatocellular carcinoma in segment 4 (arrowheads) with no evidence of viable tumor.
Mentions: All patients underwent contrast-enhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) within 40 days before the chemoembolization procedure. The methods and techniques of chemoembolization at our institution are summarized as follows: First, arteriography of the celiac and superior mesenteric arteries was performed with a 5-Fr angiographic catheter (RH catheter; Cook, Bloomington, IN, USA) to evaluate the anatomical variation of the hepatic arteries, the location and extent of the HCC, and the tumor-feeding arteries. Selective chemoembolization of the subsegmental hepatic artery was initially considered and performed in all technically feasible cases to minimize procedure-related complications such as hepatic function deterioration. After the microcatheter with a 2.0-Fr tip (Progreat; Terumo, Tokyo, Japan) or a 2.4-Fr tip (Microferret-18; Cook) was advanced into the most distal branches of the tumor-feeding artery that were technically accessible, an emulsion of iodized oil (Lipiodol; Laboratoire Andre Guerbet, Aulnay-sous-Bois, France) mixed with doxorubicin hydrochloride (Adriamycin RDF; Ildong, Seoul, Korea) was infused via the microcatheter until a decrease in the blood flow to the tumor was observed (Fig. 1). The mean dose of doxorubicin hydrochloride was 26.0 ± 12.1 mg, and the median dose was 30 mg. Additional embolization was performed with 1 mm-sized absorbable gelatin sponge particles (Gelform; Upjohn, Kalamanzoo, MI, USA or Cutanplast; Mascia Brunelli, Milan, Italy) to maximize the therapeutic effect of the chemoembolization.

Bottom Line: Major complications were observed in five (9.1%) patients who were all beyond the Milan criteria: two hepatic failures, one hepatic encephalopathy, and two CTCAE grade 3 increases in aspartate aminotransferase/alanine aminotransferase abnormality.The tumor responses of the patients who met the Milan criteria were significantly higher (p = 0.014) than those of the patients who did not.The overall median survival was 7.1 months (95% confidence interval: 4.4-9.8 months).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.

ABSTRACT

Objective: To evaluate the safety and clinical outcomes of chemoembolization in Child-Pugh class C patients with hepatocellular carcinomas (HCC).

Materials and methods: The study comprised 55 patients with HCC who were classified as Child-Pugh class C and who underwent initial chemoembolization between January 2003 and December 2012. Selective chemoembolization was performed in all technically feasible cases to minimize procedure-related complications. All adverse events within 30 days were recorded using the Common Terminology Criteria for Adverse Events (CTCAE). The tumor response to chemoembolization was evaluated using the modified Response Evaluation Criteria In Solid Tumors.

Results: Thirty (54.5%) patients were within the Milan criteria, and 25 (45.5%) were beyond. The mortality of study subjects at 30 days was 5.5%. Major complications were observed in five (9.1%) patients who were all beyond the Milan criteria: two hepatic failures, one hepatic encephalopathy, and two CTCAE grade 3 increases in aspartate aminotransferase/alanine aminotransferase abnormality. The mean length of hospitalization was 6.3 ± 8.3 days (standard deviation), and 18 (32.7%) patients were discharged on the next day after chemoembolization. The tumor responses of the patients who met the Milan criteria were significantly higher (p = 0.014) than those of the patients who did not. The overall median survival was 7.1 months (95% confidence interval: 4.4-9.8 months).

Conclusion: Even in patients with Child-Pugh class C, chemoembolization can be performed safely with a selective technique in selected cases with a small tumor burden.

No MeSH data available.


Related in: MedlinePlus