Eleni A. Liapi MD, Presenter: Nothing to Disclose

Timothy Pawlik MD, Abstract Co-Author: Nothing to Disclose

Kwang-Hun Lee MD, Abstract Co-Author: Nothing to Disclose

Kelvin Hong MD, Abstract Co-Author: Speaker, Boston Scientific Corporation

Christos S. Georgiades MD, PhD, Abstract Co-Author: Nothing to Disclose

Ihab R. Kamel MD, PhD, Abstract Co-Author: Research grant, Bracco Group Research grant, Bayer AG

Jean-Francois H. Geschwind MD, Abstract Co-Author: Grant, Boston Scientific Corporation Grant, Genentech, Inc Grant, Biocompatibles International plc Grant, MDS Inc Consultant, Biocompatibles International plc Consultant, MDS Inc Consultant, Terumo Corporation Consultant, BioSphere Medical, Inc Patent holder, 3-BrPa for Targeting Tumor Metabolism

et al, Abstract Co-Author: Nothing to Disclose

Selective transarterial chemoembolization (TACE) and portal vein embolization (PVE) could improve the rate of hypertrophy of the future liver remnant (FLR) in patients with hepatocelluar carcinoma (HCC) and liver cirrhosis. Our aim was to evaluate the feasibility and efficacy of this combined procedure.

Between November 2001 and January 2008, 7 patients with cirrhosis and HCC underwent one or more sessions of TACE, followed by PVE. TACE was performed with three chemotherapeutic agents, lipiodol and non-occlusive embolization, or with doxorubicin-loaded microspheres. Radiological tumor response was assessed by MR and/or CT imaging. PVE was performed 3-4 weeks after the last TACE session with a percutaneous transhepatic approach. N-butyl 2-cyano- acrylate (NCBA) and lipiodol were used to occlude the portal system and promote FLR hypertrophy. FLR hypertrophy was assessed with comparison of MR or CT scans obtained before and 4-6 weeks after PVE. Effectiveness evaluation was based on changes in absolute FLR size and ratio of FLR to total estimated liver volume (TELV). Safety of PVE was determined with peri- and post-procedural complication rate and median hospital stay.

All patients (6 male, 1 female, mean age: 55 years) underwent successful TACE (range: 1-3 sessions) before PVE. There was a mean maximal diameter tumor change of 10%, with a mean 30% decrease in arterial enhancement after TACE. PVE was well tolerated well in all patients. There was a mean increase in percentage FLR volume of 20%, corresponding to an 8% increase of the FLR/TELV ratio after PVE. In 2 patients there was an additional 10% decrease in maximal tumor diameter after PVE. There were neither peri-, nor post-procedural complications and all patients had a single day hospital stay.

Preoperative TACE and PVE before operation is feasible and safe, leading to an increase of hypertrophy of the FLR and to a high rate of complete tumor necrosis.

In this small series, we report our experience with combined pre-operative PVE and TACE in a large US liver cancer center. Currently, there are very few published reports in the literature.

Liapi, E, Pawlik, T, Lee, K, Hong, K, Georgiades, C, Kamel, I, Geschwind, J, et al, , Combined Preoperative Transcatheter Arterial Chemoembolization(s) and Portal Vein Embolization in Patients with Cirrhosis and Hepatocellular Carcinoma: Safety and Efficacy.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/7122264.html