269P - Transarterial ethanol ablation combined with transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Cytotoxic agents
Hepatobiliary Cancers
Surgical oncology
Presenter Biao Yang
Citation Annals of Oncology (2016) 27 (suppl_9): ix68-ix85. 10.1093/annonc/mdw582
Authors B. Yang, Z. Liao
  • Abdominal Oncology, West China Hospital, Huaxi, Sichuan University, 610041 - Chengdu/CN

Abstract

Background

Portal vein tumor thrombus (PVTT) can be detected in 30-62% of patients with Hepatocellular Carcinoma (HCC). HCC with PVTT is considered to have an extremely poor prognosis. The reported median survival for untreated HCC patients with PVTT is 2.7 months, whereas survival in patients without PVTT is 24.4 months. There are no effective treatment options for PVTT, especially end-stage PVTT (Vp3/Vp4). Therefore, there is a critical need for an effective treatment strategy for PVTT(Vp3/Vp4). This prospective study aimed to evaluate the technical feasibility, effectiveness and safety of transcatheter chemoembolization (TACE) for tumors in the liver parenchyma plus transarterial ethanol ablation (TEA) for PVTT(Vp3/Vp4).

Methods

A cohort study was carried out with 21 patients in the TACE+TEA group under the supervision of cone beam computed tomography and 22 patients in the TACE group. Treatment included transcatheter delivery of a lipiodol–ethanol mixture (LEM, 1:1 ratio by volume) for TEA and epirubicin–lipiodol emulsion (50 mg) for TACE.

Results

Mean survival was 7.2 months in the TACE+TEA group (1.81 ± 0.93 courses) and 3.9 months in the TACE group (1.86 ± 1.08 courses) (p = 0.006). Patients treated with TACE+TEA had better overall survival (at 3-months, 6-months and 12-months, respectively) compared to patients treated with TACE alone (90.2% vs 86.4%, 79.6% vs 59.1% and 53.1% vs 18.8%; p = 0.006). The rate of PVTT regression was higher in the TACE+TED group (89.5%) than in the TACE group (20%) (P 

Conclusions

We found that occluding the arterial supply to PVTT with the help of TEA not only resulted in recanalization of the portal vein, but also significantly improved survival. Based on the results of this study, TACE combined with TEA was more effective than TACE alone for treating HCC with PVTT. TEA for treating PVTT is safe, feasible and prolongs overall survival.

Clinical trial indentification

none

Legal entity responsible for the study

This study was sponsored by National Nature Science Foundation of China (81470141)

Funding

This study was sponsored by National Nature Science Foundation of China (81470141)

Disclosure

All authors have declared no conflicts of interest.