Transcatheter Arterial Embolization with Only Particles for the Treatment of Unresectable Hepatocellular Carcinoma

Mary Maluccio, Anne M. Covey, Leah Ben Porat, Joanna Schubert, Lynn A. Brody, Constantinos T. Sofocleous, George I. Getrajdman, William Jarnagin, Ronald DeMatteo, Leslie H. Blumgart, Yuman Fong, Karen T. Brown

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Abstract

Purpose: To determine the survival of patients with hepatocellular carcinoma (HCC) treated with a standardized method of transcatheter arterial embolization (TAE) with small embolic particles intended to impart terminal vessel blockade, and to evaluate prognostic factors that impact overall survival. Materials and Methods: A total of 322 patients with HCC who underwent 766 embolizations from January 1997 to December 2004 were retrospectively reviewed. Selective embolization of vessels feeding individual tumors was performed with small (50 μm) polyvinyl alcohol or spherical embolic particles (40-120 μm) intended to cause terminal vessel blockade. Repeat embolization was performed in cases of evidence of persistent viable tumor or development of new lesions. Patient, tumor, and treatment characteristics were prospectively recorded and tested for prognostic significance by univariate and multivariate analysis. Results: The median survival time was 21 months, with 1-, 2-, and 3-year overall survival rates of 66%, 46%, and 33%, respectively. In patients without extrahepatic disease or portal vein involvement by tumor, the overall 1-, 2-, and 3-year survival rates increased to 84%, 66%, and 51%, respectively. Okuda stage, extrahepatic disease, diffuse disease (≥5 tumors), and tumor size were independent predictors of survival on multivariate analysis. There were 90 complications (11.9%) in 75 patients, including eight deaths (2.5%), within 30 days of embolization. Conclusions: Hepatic arterial embolization with small particles to cause terminal vessel blockade is an effective treatment method for patients with unresectable HCC. These data support our hypothesis that particles alone may be the critical component of catheter-directed embolotherapy.

Original languageEnglish
Pages (from-to)862-869
Number of pages8
JournalJournal of Vascular and Interventional Radiology
Volume19
Issue number6
DOIs
StatePublished - Jun 2008

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Hepatocellular Carcinoma
Neoplasms
Survival
Therapeutics
Multivariate Analysis
Survival Rate
Therapeutic Embolization
Polyvinyl Alcohol
Portal Vein
Catheters
Liver

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Transcatheter Arterial Embolization with Only Particles for the Treatment of Unresectable Hepatocellular Carcinoma. / Maluccio, Mary; Covey, Anne M.; Porat, Leah Ben; Schubert, Joanna; Brody, Lynn A.; Sofocleous, Constantinos T.; Getrajdman, George I.; Jarnagin, William; DeMatteo, Ronald; Blumgart, Leslie H.; Fong, Yuman; Brown, Karen T.

In: Journal of Vascular and Interventional Radiology, Vol. 19, No. 6, 06.2008, p. 862-869.

Research output: Contribution to journalArticle

Maluccio, M, Covey, AM, Porat, LB, Schubert, J, Brody, LA, Sofocleous, CT, Getrajdman, GI, Jarnagin, W, DeMatteo, R, Blumgart, LH, Fong, Y & Brown, KT 2008, 'Transcatheter Arterial Embolization with Only Particles for the Treatment of Unresectable Hepatocellular Carcinoma', Journal of Vascular and Interventional Radiology, vol. 19, no. 6, pp. 862-869. https://doi.org/10.1016/j.jvir.2008.02.013
Maluccio, Mary ; Covey, Anne M. ; Porat, Leah Ben ; Schubert, Joanna ; Brody, Lynn A. ; Sofocleous, Constantinos T. ; Getrajdman, George I. ; Jarnagin, William ; DeMatteo, Ronald ; Blumgart, Leslie H. ; Fong, Yuman ; Brown, Karen T. / Transcatheter Arterial Embolization with Only Particles for the Treatment of Unresectable Hepatocellular Carcinoma. In: Journal of Vascular and Interventional Radiology. 2008 ; Vol. 19, No. 6. pp. 862-869.
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AU - Covey, Anne M.

AU - Porat, Leah Ben

AU - Schubert, Joanna

AU - Brody, Lynn A.

AU - Sofocleous, Constantinos T.

AU - Getrajdman, George I.

AU - Jarnagin, William

AU - DeMatteo, Ronald

AU - Blumgart, Leslie H.

AU - Fong, Yuman

AU - Brown, Karen T.

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N2 - Purpose: To determine the survival of patients with hepatocellular carcinoma (HCC) treated with a standardized method of transcatheter arterial embolization (TAE) with small embolic particles intended to impart terminal vessel blockade, and to evaluate prognostic factors that impact overall survival. Materials and Methods: A total of 322 patients with HCC who underwent 766 embolizations from January 1997 to December 2004 were retrospectively reviewed. Selective embolization of vessels feeding individual tumors was performed with small (50 μm) polyvinyl alcohol or spherical embolic particles (40-120 μm) intended to cause terminal vessel blockade. Repeat embolization was performed in cases of evidence of persistent viable tumor or development of new lesions. Patient, tumor, and treatment characteristics were prospectively recorded and tested for prognostic significance by univariate and multivariate analysis. Results: The median survival time was 21 months, with 1-, 2-, and 3-year overall survival rates of 66%, 46%, and 33%, respectively. In patients without extrahepatic disease or portal vein involvement by tumor, the overall 1-, 2-, and 3-year survival rates increased to 84%, 66%, and 51%, respectively. Okuda stage, extrahepatic disease, diffuse disease (≥5 tumors), and tumor size were independent predictors of survival on multivariate analysis. There were 90 complications (11.9%) in 75 patients, including eight deaths (2.5%), within 30 days of embolization. Conclusions: Hepatic arterial embolization with small particles to cause terminal vessel blockade is an effective treatment method for patients with unresectable HCC. These data support our hypothesis that particles alone may be the critical component of catheter-directed embolotherapy.

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