Safety and Efficacy of Doxorubicin Drug-Eluting Embolic Chemoembolization of Hepatocellular Carcinoma Supplied by Extrahepatic Collateral Arteries

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• 作者：R. Peter Lokken ; MD ; MPH^a ; ^b ; ^{r.p.lokken@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Nicholas Fidelman ; MD^b ; K. Pallav Kolli ; MD^b ; Robert K. Kerlan Jr ; MD^b
• 关键词：DEE ; drug-eluting embolic ; DSA ; digital subtraction angiography ; HCC ; hepatocellular carcinoma ; LIPA ; left inferior phrenic artery ; RIPA ; right inferior phrenic artery
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：27
• 期：11
• 页码：1698-1704
• 全文大小：4919 K

文摘

To assess safety and efficacy of doxorubicin drug-eluting embolic (DEE) transarterial chemoembolization of hepatocellular carcinoma (HCC) by extrahepatic collateral arteries.

Materials and Methods

Records of 177 patients with HCC who underwent 338 consecutive DEE chemoembolization procedures from 2011 to 2014 were retrospectively reviewed. A subgroup of 16 patients (13 men, 3 women, median age 66 y) underwent 24 procedures for 17 HCCs via extrahepatic arteries and was included in the study. Median tumor size was 3.1 cm (range, 1.0–10.3 cm). Extrahepatic collaterals included right inferior phrenic (19 procedures; 12 patients), adrenal (4 procedures; 3 patients), and cystic arteries (2 procedures; 2 patients). Radiographic response was assessed by Modified Response Evaluation Criteria in Solid Tumors criteria. Complications were defined by National Cancer Institute Common Terminology Criteria for Adverse Events.

Results

DEE chemoembolization achieved stable disease in 6 (35.3%), partial response in 6 (35.3%), and complete response in 4 (23.5%) HCCs. Disease progression was ultimately observed in 8 tumors (47.1%), with mean time to progression of 8.3 months after chemoembolization (range, 2–13 mo). Three minor and 5 major complications occurred in 8 patients; 2 minor complications were rash in vascular distribution after right inferior phrenic artery DEE chemoembolization. The 5 major complications were transient hepatotoxicity that resolved within 4–80 days; 1 was accompanied by pleural effusion requiring hospitalization. A mean 13.4 months after DEE chemoembolization, 67% of transplant candidates proceeded to liver transplant.

Conclusions

DEE transarterial chemoembolization via extrahepatic collaterals was effective and facilitated bridging to transplant. It was generally well tolerated; transient hepatotoxicity was the most common major complication.