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Analysis of efficacy and safety of terminal chemoembolization with polyvinyl alcohol for hepatocellular carcinoma with hepatic arteriovenous shunts

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Author:
No author available
Journal Title:
Chinese Journal of Radiology
Issue:
10
DOI:
10.3760/cma.j.issn.1005-1201.2015.10.010
Key Word:
癌,肝细胞;化疗栓塞,治疗性;疗效分析;Carcinoma,hepatocellular;Chemoembolization,therapeutic;Treatment outcome

Abstract: Objective To evaluate the efficacy and safety of terminal chemoembolization in hepatocellular carcinoma (HCC) with hepatic arteriovenous shunts (HAVS) by polyvinyl alcohol (PVA) plus chemotherapeutic agents or chemotherapeutic agents lipiodol emulsion (CALE). Methods The medical records of 97 patients with HCC and HAVS were retrospectively analyzed. HAVS was classified into 3 types according to the timing of visualization of the arterial to venous (A-V) on arteriogram images: slow-flow HAVS (n=36), intermediate-flow HAVS (n=40) and high-flow HAVS (n=21). The size of the PVA used was determined by the following scheme: slow-flow HAVS: 300 to 500 μm; intermediate-flow HAVS: 501 to 710 μm; high-flow HAVS: 711 to 1000 μm PVA. The HCCs with slow-flow and intermediate-flow HAVS were embolized by CALE and PVA, while the High-flow HAVS were treated by PVA with chemotherapeutic agents. Survival curves were calculated by Kaplan-Meier method and compared by Log-Rank test. Postoperative complications were analyzed. Results The median overall survival (OS) was 281 days, and the 6-month, 12-month and 18-month survival rate of 97 patients with HCC and HAVS were 67.0%, 37.2%and 14.2%, respectively. The disease control rate (DCR) was 35.2%(19/54). In rate of overall survival, there was a statistically significant difference between disease control group[median OS was 521 days(223 to 818 days)] and disease progression group[median OS was 281 days(125 to 436 days)] (χ2=4.853,P=0.028). The median OS of patients with the high-flow type, intermediate-flow type and slow-flow type were 211, 230 and 378 days, respectively. There was no statistically significant difference among different HAVS types (χ2=3.20,P=0.20).The extents of embolization showed statistically significant difference (χ2=22.14,P<0.01) among different HAVS types. The Child-Pugh class C was found in 11 cases, acute liver failure occurred in 1 case, and esophageal varices bleeding happened in 3 cases. The mortality of 30-d was 4.1% (4/97), and 3 patients died of esophageal gastric varices bleeding. Conclusion It is safe and effective to treat HCC with HAVS by the terminal chemoembolization therapy with PVA plus chemotherapeutic agents (or CALE).

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