Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

• Published in: Cardiovascular and interventional radiology Vol. 38; no. 4; pp. 913 - 921
• Main Authors: Padia, Siddharth A., Chewning, Rush H., Kogut, Matthew J., Ingraham, Christopher R., Johnson, Guy E., Bhattacharya, Renuka, Kwan, Sharon W., Monsky, Wayne L., Vaidya, Sandeep, Hippe, Daniel S., Valji, Karim
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2015; Springer Nature B.V
• Subjects: ABLATION; Adult; Aged; BIOMEDICAL RADIOGRAPHY; Brachytherapy; BYPASSES; Carcinoma, Hepatocellular - surgery; Carcinoma, Hepatocellular - therapy; Cardiology; Catheter Ablation; Chemoembolization, Therapeutic; CHILDREN; Clinical Investigation; COMPARATIVE EVALUATIONS; DIAGNOSIS; ETIOLOGY; Female; HEPATOMAS; Humans; Imaging; LIVER; Liver Neoplasms - surgery; Liver Neoplasms - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; PATIENTS; Portasystemic Shunt, Transjugular Intrahepatic; RADIOEMBOLIZATION; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Retrospective Studies; SAFETY; TOXICITY; Treatment Outcome; Ultrasound; VASCULAR DISEASES; WHO; YTTRIUM 90; Yttrium Radioisotopes - therapeutic use; Liver transplant; Hepatocellular carcinoma; yttrium-90 radioembolization; Ablation; Chemoembolization
• DOI: 10.1007/s00270-014-1009-8
• ISSN: 0174-1551

Purpose Locoregional therapy for hepatocellular carcinoma (HCC) can be challenging in patients with a transjugular intrahepatic portosystemic shunt (TIPS). This study compares safety and imaging response of ablation, chemoembolization, radioembolization, and supportive care in patients with both TIPS and HCC. Methods This retrospective study included 48 patients who had both a TIPS and a diagnosis of HCC. Twenty-nine of 48 (60 %) underwent treatment for HCC, and 19/48 (40 %) received best supportive care (i.e., symptomatic management only). While etiology of cirrhosis and indication for TIPS were similar between the two groups, treated patients had better baseline liver function (34 vs. 67 % Child-Pugh class C). Tumor characteristics were similar between the two groups. A total of 39 ablations, 17 chemoembolizations, and 10 yttrium-90 radioembolizations were performed on 29 patients. Results Ablation procedures resulted in low rates of hepatotoxicity and clinical toxicity. Post-embolization/ablation syndrome occurred more frequently in patients undergoing chemoembolization than ablation (47 vs. 15 %). Significant hepatic dysfunction occurred more frequently in the chemoembolization group than the ablation group. Follow-up imaging response showed objective response in 100 % of ablation procedures, 67 % of radioembolization procedures, and 50 % of chemoembolization procedures ( p  = 0.001). When censored for OLT, patients undergoing treatment survived longer than patients receiving supportive care (2273 v. 439 days, p  = 0.001). Conclusions Ablation appears to be safe and efficacious for HCC in patients with TIPS. Catheter-based approaches are associated with potential increased toxicity in this patient population. Chemoembolization appears to be associated with increased toxicity compared to radioembolization.