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Author Padia, Siddharth A. ♦ Chewning, Rush H. ♦ Kogut, Matthew J. ♦ Ingraham, Christopher R. ♦ Johnson, Guy E. ♦ Bhattacharya, Renuka ♦ Kwan, Sharon W. ♦ Monsky, Wayne L. ♦ Vaidya, Sandeep ♦ Hippe, Daniel S. ♦ Valji, Karim
Source United States Department of Energy Office of Scientific and Technical Information
Content type Text
Language English
Subject Keyword RADIOLOGY AND NUCLEAR MEDICINE ♦ ABLATION ♦ BIOMEDICAL RADIOGRAPHY ♦ BYPASSES ♦ CHILDREN ♦ COMPARATIVE EVALUATIONS ♦ DIAGNOSIS ♦ ETIOLOGY ♦ HEPATOMAS ♦ LIVER ♦ PATIENTS ♦ RADIOEMBOLIZATION ♦ SAFETY ♦ TOXICITY ♦ VASCULAR DISEASES ♦ WHO ♦ YTTRIUM 90
Abstract PurposeLocoregional therapy for hepatocellular carcinoma (HCC) can be challenging in patients with a transjugular intrahepatic portosystemic shunt (TIPS). This study compares safety and imaging response of ablation, chemoembolization, radioembolization, and supportive care in patients with both TIPS and HCC.MethodsThis retrospective study included 48 patients who had both a TIPS and a diagnosis of HCC. Twenty-nine of 48 (60 %) underwent treatment for HCC, and 19/48 (40 %) received best supportive care (i.e., symptomatic management only). While etiology of cirrhosis and indication for TIPS were similar between the two groups, treated patients had better baseline liver function (34 vs. 67 % Child-Pugh class C). Tumor characteristics were similar between the two groups. A total of 39 ablations, 17 chemoembolizations, and 10 yttrium-90 radioembolizations were performed on 29 patients.ResultsAblation procedures resulted in low rates of hepatotoxicity and clinical toxicity. Post-embolization/ablation syndrome occurred more frequently in patients undergoing chemoembolization than ablation (47 vs. 15 %). Significant hepatic dysfunction occurred more frequently in the chemoembolization group than the ablation group. Follow-up imaging response showed objective response in 100 % of ablation procedures, 67 % of radioembolization procedures, and 50 % of chemoembolization procedures (p = 0.001). When censored for OLT, patients undergoing treatment survived longer than patients receiving supportive care (2273 v. 439 days, p = 0.001).ConclusionsAblation appears to be safe and efficacious for HCC in patients with TIPS. Catheter-based approaches are associated with potential increased toxicity in this patient population. Chemoembolization appears to be associated with increased toxicity compared to radioembolization.
ISSN 01741551
Educational Use Research
Learning Resource Type Article
Publisher Date 2015-08-15
Publisher Place United States
Journal Cardiovascular and Interventional Radiology
Volume Number 38
Issue Number 4


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