Changes in Arterioportal Shunts in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis Who Were Treated with Chemoembolization Followed by Radiotherapy
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Purpose In this study, we retrospectively investigated the prevalence of arterioportal (AP) shunts inhepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) andevaluated the changes in AP shunts after chemoembolization followed by external beamradiation therapy (EBRT). Materials and MethodsWe analyzed 54 HCC patients with PVTT who were treated with chemoembolization followedby EBRT. EBRT was uniformly delivered at a total dose of 30 to 45 Gy (median, 35 Gy), witha daily dose of 2 to 4.5 Gy. Angiographic images of chemoembolization before and afterradiation therapy (RT) were reviewed to investigate the AP shunt. ResultsDuring the initial session of chemoembolization, 33 of 54 patients (61%) had an AP shunt. After EBRT, 32 out of 33 patients had an additional session of chemoembolization and wereevaluated for a change in the AP shunt. The AP shunt decreased in 20 of 32 patients (63%)after chemoembolization followed by EBRT. The 1-year calculated overall survival (OS) ratefor all patients was 52.6% and the 2-year OS was 36.4%. The median OS in all patients was13 months. Patients with AP shunt showed poorer median OS than those without AP shunt,but there was no statistically significant difference (median, 12 months vs. 17 months). ConclusionThe AP shunt frequently occurs in HCC patients with PVTT. This study suggests that a poorprognosis is associated with an AP shunt. Chemoembolization followed by RT may producea decrease in AP shunts.
Abstract
Purpose In this study, we retrospectively investigated the prevalence of arterioportal (AP) shunts inhepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) andevaluated the changes in AP shunts after chemoembolization followed by external beamradiation therapy (EBRT). Materials and MethodsWe analyzed 54 HCC patients with PVTT who were treated with chemoembolization followedby EBRT. EBRT was uniformly delivered at a total dose of 30 to 45 Gy (median, 35 Gy), witha daily dose of 2 to 4.5 Gy. Angiographic images of chemoembolization before and afterradiation therapy (RT) were reviewed to investigate the AP shunt. ResultsDuring the initial session of chemoembolization, 33 of 54 patients (61%) had an AP shunt. After EBRT, 32 out of 33 patients had an additional session of chemoembolization and wereevaluated for a change in the AP shunt. The AP shunt decreased in 20 of 32 patients (63%)after chemoembolization followed by EBRT. The 1-year calculated overall survival (OS) ratefor all patients was 52.6% and the 2-year OS was 36.4%. The median OS in all patients was13 months. Patients with AP shunt showed poorer median OS than those without AP shunt,but there was no statistically significant difference (median, 12 months vs. 17 months). ConclusionThe AP shunt frequently occurs in HCC patients with PVTT. This study suggests that a poorprognosis is associated with an AP shunt. Chemoembolization followed by RT may producea decrease in AP shunts.
참고문헌 (22)
- "Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. The Cancer of the Liver Italian Program (CLIP)Investigators", Hepatology, 31, pp.840~845 (2000)
- Davidson BR, "Incidence, risk factors, management, and outcome of portal vein abnormalities at orthotopic liver transplantation", Transplantation, 57, pp.1174~1177 (1994)
- Park HC, "Multidisciplinary management of nonresectable hepatocellular carcinoma", Oncology, 81(Suppl 1), pp.134~140 (2011)
- "European Association for Study of Liver; European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma", Eur J Cancer, 48, pp.599~641 (2012)
- Okuda K, "Angiographic demonstration of intrahepatic arterio-portal anastomoses in hepatocellular carcinoma", Radiology, 122, pp.53~58 (1977)
- Ngan H, "Arteriovenous shunting in hepatocellular carcinoma : its prevalence and clinical significance", Clin Radiol, 52, pp.36~40 (1997)
- Bookstein JJ, "Arterioportal communications : observations and hypotheses concerning transsinusoidal and transvasal types", Radiology, 142, pp.581~590 (1982)
- Breen DJ, "Intrahepatic arterioportal shunting and anomalous venous drainage : understanding the CT features in the liver", Eur Radiol, 14, pp.2249~2260 (2004)
- Huang YJ, "The treatment responses in cases of radiation therapy to portal vein thrombosis in advanced hepatocellular carcinoma", Int J Radiat Oncol Biol Phys, 73, pp.1155~1163 (2009)
- Yoon SM, "Radiotherapy plus transarterial chemoembolization for hepatocellular carcinoma invading the portal vein : long-term patient outcomes", Int J Radiat Oncol Biol Phys, 82, pp.2004~2011 (2012)
- Hsu HC, "Three-dimensional conformal radiotherapy for the treatment of arteriovenous shunting in patients with hepatocellular carcinoma", Br J Radiol, 80, pp.38~42 (2007)
- 유정일, "Scheduled Interval Trans-Catheter Arterial Chemoembolization Followed by Radiation Therapy in Patients with Unresectable Hepatocellular Carcinoma", Journal of Korean Medical Science, 27(7), pp.736~743 (2012), 대한의학회[DOI]
- Oh D, "Early three-dimensional conformal radiotherapy for patients with unresectable hepatocellular carcinoma after incomplete transcatheter arterial chemoembolization : a prospective evaluation of efficacy and toxicity", Am J Clin Oncol, 33, pp.370~375 (2010)
- Lencioni R, "Modified RECIST(mRECIST)assessment for hepatocellular carcinoma", Semin Liver Dis, 30, pp.52~60 (2010)
- Huang MS, "Comparison of long-term effects between intra-arterially delivered ethanol and Gelfoam for the treatment of severe arterioportal shunt in patients with hepatocellular carcinoma", World J Gastroenterol, 10, pp.825~829 (2004)
- Ratti F, "Surgical approach to multifocal hepatocellular carcinoma with portal vein thrombosis and arterioportal shunt leading to portal hypertension and bleeding : a case report", World J Surg Oncol, 10, pp.34~ (2012)
- Nakai M, "Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloonoccluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery", World J Gastroenterol, 12, pp.5404~5407 (2006)
- Izaki K, "Transcatheter arterial embolization for advanced tumor thrombus with marked arterioportal or arteriovenous shunt complicating hepatocellular carcinoma", Radiat Med, 22, pp.155~162 (2004)
- Murata S, "Initial experience of transcatheter arterial chemoembolization during portal vein occlusion for unresectable hepatocellular carcinoma with marked arterioportal shunts", Eur Radiol, 19, pp.2016~2023 (2009)
- Sugano S, "Intrahepatic arteriovenous shunting due to hepatocellular carcinoma and cirrhosis, and its change by transcatheter arterial embolization", Am J Gastroenterol, 89, pp.184~188 (1994)
- Schneider BF, "Histopathology of arteriovenous malformations after gamma knife radiosurgery", J Neurosurg, 87, pp.352~357 (1997)
- Furuse J, "Hepatocellular carcinoma with portal vein tumor thrombus : embolization of arterioportal shunts", Radiology, 204, pp.787~790 (1997)