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Efficacy and safety of transarterial chemoembolization using drug eluting beads for hepatocellular carcinoma
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Electronic Poster Abstracts
our institute from January 2007 to December 2013 were enrolled in this study. Patients were divided into recurrent and non-recurrent groups, and the recurrent group was further divided into four subgroups by applying two criteria, that is, early and late recurrence, and single and multiple recurrence. Potential risk factors were compared by univariate and multivariate analyses. Subgroup analysis was performed to determine the effects of cut-off values on the analysis.41 recurrences (44.6%) occurred during a mean follow-up of 42.4 months. Child-Pugh score and portal vein invasion were found to be independent risk factors of recurrence, but differentiation was the only independent risk factor of early recurrence identified. Serum alpha-fetoprotein, tumor size, tumor necrosis, and hemorrhage were found to be risk factors of multiple recurrence by univariate analysis, but lacked significance by multivariate analysis. However, when the cutoffs of early and multiple recurrences were changed to < 10 months and >3 nodules different risk factors were identified. Different factors govern intrahepatic, early, and multiple HCC recurrence, this finding confirms a complex relationship exists between chronicity and multiplicity in recurrent HCC.
EP01B-085 EFFICACY AND SAFETY OF TRANSARTERIAL CHEMOEMBOLIZATION USING DRUG ELUTING BEADS FOR HEPATOCELLULAR CARCINOMA A. Deguchi1, J. Kageyama2 and T. Masaki3 1 Division of Gastroenterology, 2Division of Radiology, Kagawa Rosai Hospital, and 3Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan Introduction: Transarterial chemoembolization (TACE) using a drug-eluting bead (DEB-TACE) for hepatocellular carcinoma (HCC) is a new treatment method in Japan. In this study we evaluated the efficacy and safety of DEBTACE for the patients with unresectable hepatocellular carcinoma. Methods: 62 patients (M: F = 52:10, age (mean) 68, Child A: B = 39:23, BCLC stage A: B: C = 1: 47: 14) with unresectable HCC those received DEB TACE procedures in our hospital were studied. DEB TACE procedures using HepaSphere eluting CDDP in 32 sessions and DC Bead eluting epirubicin in 30 sessions were performed. The objective radiological response was classified according to Response Evaluation Criteria in Solid Tumors (RECIST) v.1.1 by dynamic CT at one month after therapy. Adverse events were evaluated using NCI CTCAE v. 4.03. Results: The imaging response was assessed in each session as complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) in 2 (3%), 24 (39%), 24 (40%), and 11 (18%) respectively. In most effective case, huge HCC that was 96mm in tumor diameter became smaller as 45 mm and also in the tumor marker, AFP decreased from 102.4 to 5.4 and PIVKAII decreased from 31400 to 34 after 3 session of DEB-TACE. As the complication, grade 1 level of pyrexia, vomiting, and abdominal pain were observed in 17%, 6%, and 11%
respectively. There was no case in which Child-Pugh score got worse except for the case with PD. Conclusion: DEB-TACE is safe and effective in achieving local tumor control in patients with unresectable HCC.
EP01B-086 DIAPHRAGMATIC HERNIA DEVELOPED AFTER RADIOFREQUENCY ABLATION FOR HEPATOCELLULAR CARCINOMA: REPORT OF THREE CASES E. K. Park1, C. K. Cho2, Y. S. Koh2, H. J. Kim1, Y. H. Hur2, H. J. Kim2 and B. G. Choi3 1 Department of Surgery, Division of HBP, Chonnam National University Hospital, 2Department of Surgery, Division of HBP, Chonnam National University Medical School, and 3Department of Gurgery, Suhgwang Hospital, Republic of Korea Radiofrequency ablation (RFA) has been widely accepted treatment for hepatocellular carcinoma (HCC) as primary choice for small HCC or alternative for unresectable cases. Because of its safety and effectiveness with a low mortality rate and a low major complication rate, the popularity of RFA has gradually increased. However, delayed diaphragmatic hernia can occur as a result of this procedure. There have been only ten other cases reported on this complication. The current case report presents three cases of delayed onset diaphragmatic hernia following RFA. These three patients were performed percutaneous RFA for the treatment of HCC. Patients presented emergency department due to abdominal pain and vomiting. Computed tomography and chest PA revealed diaphragmatic hernia, showing colonic loops in the thoracic cavity. Duration from RFA to presenting abdominal was 19 months, 23 months and 38 months, respectively. The location of Hepatic lesion of HCC were hepatic dome, namely at the segment 7 of 2 cases and segment 4a of one case. One case were suspected diaphragmatic thermal injury at the time of RFA procedure on abdominal CT, but follow-up CT after 3 months shows no diaphragmatic injury or bowel herniation, so we decided to observe. We performed emergency operation of diaphragmatic repair in two cases. However one case was tried to repair diaphragmatic defect, but owing to severe adhesion, we couldn’t approach the lesion. Patients who have undergone RFA for a hepatic tumor adjacent to the diaphragm should be carefully followed up for possible diaphragmatic hernia, even after a long postprocedural interval.
EP01B-087 DIFFUSE HEPATOCELLULAR CARCINOMA: A DIAGNOSTIC CHALLENGE A. Cristiano1, M. Lenz2, E. Quiñonez2, R. Vergara Sandoval2, N. Daciuk2, F. Villamil2 and J. Mattera1 1 Liver Transplant and HPB Surgery, and 2Hospital El Cruce, Argentina HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
our institute from January 2007 to December 2013 were enrolled in this study. Patients were divided into recurrent and non-recurrent groups, and the recurrent group was further divided into four subgroups by applying two criteria, that is, early and late recurrence, and single and multiple recurrence. Potential risk factors were compared by univariate and multivariate analyses. Subgroup analysis was performed to determine the effects of cut-off values on the analysis.41 recurrences (44.6%) occurred during a mean follow-up of 42.4 months. Child-Pugh score and portal vein invasion were found to be independent risk factors of recurrence, but differentiation was the only independent risk factor of early recurrence identified. Serum alpha-fetoprotein, tumor size, tumor necrosis, and hemorrhage were found to be risk factors of multiple recurrence by univariate analysis, but lacked significance by multivariate analysis. However, when the cutoffs of early and multiple recurrences were changed to < 10 months and >3 nodules different risk factors were identified. Different factors govern intrahepatic, early, and multiple HCC recurrence, this finding confirms a complex relationship exists between chronicity and multiplicity in recurrent HCC.
EP01B-085 EFFICACY AND SAFETY OF TRANSARTERIAL CHEMOEMBOLIZATION USING DRUG ELUTING BEADS FOR HEPATOCELLULAR CARCINOMA A. Deguchi1, J. Kageyama2 and T. Masaki3 1 Division of Gastroenterology, 2Division of Radiology, Kagawa Rosai Hospital, and 3Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan Introduction: Transarterial chemoembolization (TACE) using a drug-eluting bead (DEB-TACE) for hepatocellular carcinoma (HCC) is a new treatment method in Japan. In this study we evaluated the efficacy and safety of DEBTACE for the patients with unresectable hepatocellular carcinoma. Methods: 62 patients (M: F = 52:10, age (mean) 68, Child A: B = 39:23, BCLC stage A: B: C = 1: 47: 14) with unresectable HCC those received DEB TACE procedures in our hospital were studied. DEB TACE procedures using HepaSphere eluting CDDP in 32 sessions and DC Bead eluting epirubicin in 30 sessions were performed. The objective radiological response was classified according to Response Evaluation Criteria in Solid Tumors (RECIST) v.1.1 by dynamic CT at one month after therapy. Adverse events were evaluated using NCI CTCAE v. 4.03. Results: The imaging response was assessed in each session as complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) in 2 (3%), 24 (39%), 24 (40%), and 11 (18%) respectively. In most effective case, huge HCC that was 96mm in tumor diameter became smaller as 45 mm and also in the tumor marker, AFP decreased from 102.4 to 5.4 and PIVKAII decreased from 31400 to 34 after 3 session of DEB-TACE. As the complication, grade 1 level of pyrexia, vomiting, and abdominal pain were observed in 17%, 6%, and 11%
respectively. There was no case in which Child-Pugh score got worse except for the case with PD. Conclusion: DEB-TACE is safe and effective in achieving local tumor control in patients with unresectable HCC.
EP01B-086 DIAPHRAGMATIC HERNIA DEVELOPED AFTER RADIOFREQUENCY ABLATION FOR HEPATOCELLULAR CARCINOMA: REPORT OF THREE CASES E. K. Park1, C. K. Cho2, Y. S. Koh2, H. J. Kim1, Y. H. Hur2, H. J. Kim2 and B. G. Choi3 1 Department of Surgery, Division of HBP, Chonnam National University Hospital, 2Department of Surgery, Division of HBP, Chonnam National University Medical School, and 3Department of Gurgery, Suhgwang Hospital, Republic of Korea Radiofrequency ablation (RFA) has been widely accepted treatment for hepatocellular carcinoma (HCC) as primary choice for small HCC or alternative for unresectable cases. Because of its safety and effectiveness with a low mortality rate and a low major complication rate, the popularity of RFA has gradually increased. However, delayed diaphragmatic hernia can occur as a result of this procedure. There have been only ten other cases reported on this complication. The current case report presents three cases of delayed onset diaphragmatic hernia following RFA. These three patients were performed percutaneous RFA for the treatment of HCC. Patients presented emergency department due to abdominal pain and vomiting. Computed tomography and chest PA revealed diaphragmatic hernia, showing colonic loops in the thoracic cavity. Duration from RFA to presenting abdominal was 19 months, 23 months and 38 months, respectively. The location of Hepatic lesion of HCC were hepatic dome, namely at the segment 7 of 2 cases and segment 4a of one case. One case were suspected diaphragmatic thermal injury at the time of RFA procedure on abdominal CT, but follow-up CT after 3 months shows no diaphragmatic injury or bowel herniation, so we decided to observe. We performed emergency operation of diaphragmatic repair in two cases. However one case was tried to repair diaphragmatic defect, but owing to severe adhesion, we couldn’t approach the lesion. Patients who have undergone RFA for a hepatic tumor adjacent to the diaphragm should be carefully followed up for possible diaphragmatic hernia, even after a long postprocedural interval.
EP01B-087 DIFFUSE HEPATOCELLULAR CARCINOMA: A DIAGNOSTIC CHALLENGE A. Cristiano1, M. Lenz2, E. Quiñonez2, R. Vergara Sandoval2, N. Daciuk2, F. Villamil2 and J. Mattera1 1 Liver Transplant and HPB Surgery, and 2Hospital El Cruce, Argentina HPB 2016, 18 (S1), e1ee384