Sequential intra-arterial therapy and portal vein embolization is feasible and safe in patients with advanced hepatic malignancies

Peter D. Peng, Omar Hyder, Mark Bloomston, Hugo Marques, Celia Corona Villalobos, Elijah Dixon, Carlo Pulitano, Kenzo Hirose, Richard D. Schulick, Eduardo Barroso, Luca Aldrighetti, Michael Choti, Feng Shen, Ihab R Kamel, Jean Francois H Geschwind, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: A major hepatic resection for malignancies requires an adequate post-operative liver reserve. Portal vein embolization (PVE) with intra-arterial therapy (IAT) may increase future liver remnant (FLR) hypertrophy. As such, the feasibility, safety and efficacy of IAT+PVE were investigated. Methods: Between 2000 to 2011, 86 patients with malignancy of the liver were identified from a multi-institutional database. Twenty-nine patients underwent sequential IAT+PVE, 25 had PVE alone and 32 had IAT alone. Clinicopathological data were evaluated. Results: Most patients had hepatocellular carcinoma (HCC) (65.1%) and 31.4% had secondary metastatic disease. A complete or partial response using European Association for the Study of the Liver (EASLD) criteria was seen in 48.3% of patients undergoing IAT+PVE vs. 56.6% among patients undergoing IAT (P = 0.601). The median increase in percentage FLR volume was comparable in IAT+PVE (7.4%) vs. PVE only (7.9%) (P = 0.203). There were no IAT+PVE-associated deaths and only one complication. Among patients treated with IAT+PVE (n = 29), 27 underwent a subsequent hepatic resection. Peri-operative morbidity and mortality was 29.6% and 7.4%, respectively. Among the patients with HCC who underwent curative intent surgery after IAT+PVE, the median survival was 59.0 months. Conclusions: Sequential IAT and PVE are feasible and safe. Utilization of IAT+PVE before a resection can lead to long-term survival and should be considered in the treatment of patients with advanced hepatic malignancies.

Original languageEnglish (US)
Pages (from-to)523-531
Number of pages9
JournalHPB
Volume14
Issue number8
DOIs
StatePublished - Aug 2012

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Portal Vein
Liver
Neoplasms
Therapeutics
Hepatocellular Carcinoma
Survival
Hypertrophy
Databases
Morbidity

Keywords

  • Chemoembolization
  • Liver
  • Malignancy
  • Outcome
  • Portal vein embolization
  • Safety

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Sequential intra-arterial therapy and portal vein embolization is feasible and safe in patients with advanced hepatic malignancies. / Peng, Peter D.; Hyder, Omar; Bloomston, Mark; Marques, Hugo; Corona Villalobos, Celia; Dixon, Elijah; Pulitano, Carlo; Hirose, Kenzo; Schulick, Richard D.; Barroso, Eduardo; Aldrighetti, Luca; Choti, Michael; Shen, Feng; Kamel, Ihab R; Geschwind, Jean Francois H; Pawlik, Timothy M.

In: HPB, Vol. 14, No. 8, 08.2012, p. 523-531.

Research output: Contribution to journalArticle

Peng, PD, Hyder, O, Bloomston, M, Marques, H, Corona Villalobos, C, Dixon, E, Pulitano, C, Hirose, K, Schulick, RD, Barroso, E, Aldrighetti, L, Choti, M, Shen, F, Kamel, IR, Geschwind, JFH & Pawlik, TM 2012, 'Sequential intra-arterial therapy and portal vein embolization is feasible and safe in patients with advanced hepatic malignancies', HPB, vol. 14, no. 8, pp. 523-531. https://doi.org/10.1111/j.1477-2574.2012.00492.x
Peng, Peter D. ; Hyder, Omar ; Bloomston, Mark ; Marques, Hugo ; Corona Villalobos, Celia ; Dixon, Elijah ; Pulitano, Carlo ; Hirose, Kenzo ; Schulick, Richard D. ; Barroso, Eduardo ; Aldrighetti, Luca ; Choti, Michael ; Shen, Feng ; Kamel, Ihab R ; Geschwind, Jean Francois H ; Pawlik, Timothy M. / Sequential intra-arterial therapy and portal vein embolization is feasible and safe in patients with advanced hepatic malignancies. In: HPB. 2012 ; Vol. 14, No. 8. pp. 523-531.
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abstract = "Background: A major hepatic resection for malignancies requires an adequate post-operative liver reserve. Portal vein embolization (PVE) with intra-arterial therapy (IAT) may increase future liver remnant (FLR) hypertrophy. As such, the feasibility, safety and efficacy of IAT+PVE were investigated. Methods: Between 2000 to 2011, 86 patients with malignancy of the liver were identified from a multi-institutional database. Twenty-nine patients underwent sequential IAT+PVE, 25 had PVE alone and 32 had IAT alone. Clinicopathological data were evaluated. Results: Most patients had hepatocellular carcinoma (HCC) (65.1{\%}) and 31.4{\%} had secondary metastatic disease. A complete or partial response using European Association for the Study of the Liver (EASLD) criteria was seen in 48.3{\%} of patients undergoing IAT+PVE vs. 56.6{\%} among patients undergoing IAT (P = 0.601). The median increase in percentage FLR volume was comparable in IAT+PVE (7.4{\%}) vs. PVE only (7.9{\%}) (P = 0.203). There were no IAT+PVE-associated deaths and only one complication. Among patients treated with IAT+PVE (n = 29), 27 underwent a subsequent hepatic resection. Peri-operative morbidity and mortality was 29.6{\%} and 7.4{\%}, respectively. Among the patients with HCC who underwent curative intent surgery after IAT+PVE, the median survival was 59.0 months. Conclusions: Sequential IAT and PVE are feasible and safe. Utilization of IAT+PVE before a resection can lead to long-term survival and should be considered in the treatment of patients with advanced hepatic malignancies.",
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T1 - Sequential intra-arterial therapy and portal vein embolization is feasible and safe in patients with advanced hepatic malignancies

AU - Peng, Peter D.

AU - Hyder, Omar

AU - Bloomston, Mark

AU - Marques, Hugo

AU - Corona Villalobos, Celia

AU - Dixon, Elijah

AU - Pulitano, Carlo

AU - Hirose, Kenzo

AU - Schulick, Richard D.

AU - Barroso, Eduardo

AU - Aldrighetti, Luca

AU - Choti, Michael

AU - Shen, Feng

AU - Kamel, Ihab R

AU - Geschwind, Jean Francois H

AU - Pawlik, Timothy M.

PY - 2012/8

Y1 - 2012/8

N2 - Background: A major hepatic resection for malignancies requires an adequate post-operative liver reserve. Portal vein embolization (PVE) with intra-arterial therapy (IAT) may increase future liver remnant (FLR) hypertrophy. As such, the feasibility, safety and efficacy of IAT+PVE were investigated. Methods: Between 2000 to 2011, 86 patients with malignancy of the liver were identified from a multi-institutional database. Twenty-nine patients underwent sequential IAT+PVE, 25 had PVE alone and 32 had IAT alone. Clinicopathological data were evaluated. Results: Most patients had hepatocellular carcinoma (HCC) (65.1%) and 31.4% had secondary metastatic disease. A complete or partial response using European Association for the Study of the Liver (EASLD) criteria was seen in 48.3% of patients undergoing IAT+PVE vs. 56.6% among patients undergoing IAT (P = 0.601). The median increase in percentage FLR volume was comparable in IAT+PVE (7.4%) vs. PVE only (7.9%) (P = 0.203). There were no IAT+PVE-associated deaths and only one complication. Among patients treated with IAT+PVE (n = 29), 27 underwent a subsequent hepatic resection. Peri-operative morbidity and mortality was 29.6% and 7.4%, respectively. Among the patients with HCC who underwent curative intent surgery after IAT+PVE, the median survival was 59.0 months. Conclusions: Sequential IAT and PVE are feasible and safe. Utilization of IAT+PVE before a resection can lead to long-term survival and should be considered in the treatment of patients with advanced hepatic malignancies.

AB - Background: A major hepatic resection for malignancies requires an adequate post-operative liver reserve. Portal vein embolization (PVE) with intra-arterial therapy (IAT) may increase future liver remnant (FLR) hypertrophy. As such, the feasibility, safety and efficacy of IAT+PVE were investigated. Methods: Between 2000 to 2011, 86 patients with malignancy of the liver were identified from a multi-institutional database. Twenty-nine patients underwent sequential IAT+PVE, 25 had PVE alone and 32 had IAT alone. Clinicopathological data were evaluated. Results: Most patients had hepatocellular carcinoma (HCC) (65.1%) and 31.4% had secondary metastatic disease. A complete or partial response using European Association for the Study of the Liver (EASLD) criteria was seen in 48.3% of patients undergoing IAT+PVE vs. 56.6% among patients undergoing IAT (P = 0.601). The median increase in percentage FLR volume was comparable in IAT+PVE (7.4%) vs. PVE only (7.9%) (P = 0.203). There were no IAT+PVE-associated deaths and only one complication. Among patients treated with IAT+PVE (n = 29), 27 underwent a subsequent hepatic resection. Peri-operative morbidity and mortality was 29.6% and 7.4%, respectively. Among the patients with HCC who underwent curative intent surgery after IAT+PVE, the median survival was 59.0 months. Conclusions: Sequential IAT and PVE are feasible and safe. Utilization of IAT+PVE before a resection can lead to long-term survival and should be considered in the treatment of patients with advanced hepatic malignancies.

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KW - Malignancy

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KW - Portal vein embolization

KW - Safety

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