Portal blood supply to locally progressed hepatocellular carcinoma after transcatheter arterial chemoembolization: Observation on CT during arterial portography.

Abstract

AIM:

  To analyze the clinical features of locally progressed hepatocellular carcinoma (HCC) supplied by portal blood (PB) after transcatheter arterial chemoembolization (TACE).

METHODS:

  This cohort included 12 tumors (mean diameter ± SD, 1.8 ± 0.8 cm) in 10 patients. PB supply to tumors was judged by CT during arterial portography (CTAP). Imaging data and the clinical course were retrospectively evaluated.

RESULTS:

  Six tumors initially had a small tumor portion supplied by PB. In four tumors, TACE was incomplete because of technical problems. PB supply to recurrent tumors was demonstrated 7.3 ± 3.7 months after TACE. On follow-up arteriography, all embolized branches were occluded or severely attenuated. Four tumors showing a partial stain were treated by additional TACE (n = 3) or TACE plus radiofrequency (RF) ablation (n = 1), one without staining was treated by RF ablation, and seven were followed-up. All tumors progressed except for one treated by RF ablation. On serial CTAP images, relatively large-diameter portal veins directly entered 11 tumors (91.7%) and connected with intratumoral vessels in nine (75%). During follow-up, partial arterial supply was demonstrated in two tumors and additional TACE was performed. Nine patients died after 31.4 ± 16.2 months due to tumor progression (n = 8), or hepatic failure (n = 1). One patient has survived for 53 months despite multiple tumors.

CONCLUSIONS:

  PB supply to locally progressed tumor after TACE became apparent on CTAP. Arterial damage by TACE, incomplete TACE, and preexisting tumor tissues supplied by PB may be the main causes.

• Authors: Shiro Miyayama, Osamu Matsui, Yoh Zen, Masashi Yamashiro, Yuki Hattori, Nobuaki Orito, Ken Matsui, Kazunobu Tsuji, Miki Yoshida, Yoshiko Sudo
• Journal: Hepatology research : the official journal of the Japan Society of Hepatology (Hepatol Res) Vol. 41 Issue 9 Pg. 853-66 (Sep 2011) ISSN: 1872-034X [Electronic] Netherlands
• PMID: 21699636 (Publication Type: Journal Article)
• Copyright: © 2011 The Japan Society of Hepatology.