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Outcome following hepatic artery embolization for HCC in presence of portal vein tumor
JVIR
’
Scientific Session
Tuesday
M. Fritsche, J. Watchmaker, A. Lipnik, S. Mouli, J. Baker, F. Banovac, S. Geevarghese, R. Omary, D. Brown; Vanderbilt University Medical Center, Nashville, TN Purpose: Historically, patients treated with TACE for HCC are observed (OBS) overnight. Starting in 2014, we initiated targeted same-day discharge (DC) based on low estimated morbidity. We tested the hypothesis that DC of selected patients would not increase 30-day readmission rate (30D). Materials: With IRB approval, we reviewed TACE for HCC patients from 7/2013-6/2016. Treatment was Lipiodol-TACE (cTACE) with 50 mg dox/10 mg MMC/particles or drug-eluting embolics (DEE) with 50-75 mg dox/vial. At 3 hours, patients tolerating PO intake and not requiring IV pain meds were considered for DC. The primary outcome measure was 30D for OBS vs DC using Chi-Squared (X2) analysis. The secondary aim was to identify baseline or treatment variables in the table for independent association with 30D via X2. A po0.05 was significant. Results: 191 patients underwent 261 TACE: 30D was not significant between OBS (n ¼ 179, 9.0%) and DC (n ¼ 82, 13.8%, p ¼ 0.33). 30D was not related to agent selected (cTACE 11.0% vs. DEE 7.5%, p ¼ 0.36). Variables associated with 30D were Child-Pugh B/C (X2 ¼ 7.9, po0.01), history of encephalopathy (X2 ¼ 15.4, po0.01) and ascites (X2 ¼ 4.4, po0.05). Patient age (4 or o65), tumor number (1 vs 41), and treatment selection (segmental vs lobar) all had p40.05. Conclusions: OBS does not reduce the risk of 30D. Child-Pugh B/C, ascitic and encephalopathic patients are at the highest risk of 30D.
Baseline
No
Yes
Total
A
112
9
121
B/C Encephalopathy
55
15
70
Child-Pugh class
0.0049*
o0.0001*
Yes
35
14
49
No Ascites
132
10
142
Yes
48
12
60
No
119
12
131
Procedure Data
No
Yes
Total
Modality c-TACE
138
17
155
98
8
106
DEE
3:09 PM
P Value
0.036*
P Value 0.36
Abstract No. 284
Outcome following hepatic artery embolization for HCC in presence of portal vein tumor A. Borgheresi, K. Brown, A. Covey, H. Yarmohammadi, F. Boas, E. Ziv, G. Getrajdman, J. Erinjeri, M. Gonen,
S123
S. Solomon; Memorial Sloan Kettering Cancer Center, New York, NY Purpose: To review long-term outcome of hepatic artery embolization (HAE) using small microspheres in patients presenting with portal vein tumor (PVT) over a 10-year period. Materials: All embolizations performed for HCC between December 2005 and December 2015 were reviewed, identifying 43 patients who had PVT at presentation. Information in the electronic medical record (EMR) along with imaging findings at presentation and following treatment were analyzed retrospectively. Response to treatment was evaluated using mRECIST criteria on multiphase CT obtained 3-5 weeks after treatment and at quarterly intervals thereafter. Liver function was assessed at the same time points and Child-Pugh (CP) score was calculated. Time to progression (TTP) was recorded as well as whether progression was local tumor progression (LTP), distant hepatic progression (DHP), PVT progression, and/or the development of extra-hepatic disease (EHD). Results: Forty (40/43, 95%) patients progressed during a median follow-up of 10 months with a median TTP of 2.9 months. Eleven of the 43 patients (26%) developed EHD, 23 (53%) progressed within the liver with only 2 (5%) demonstrating solely LTP. Six patients (14%) progressed only in the PVT. At the time of progression 27 (27/40, 77%) maintained their initial CP status, including all 5 CPB patients and 22 of 35 (63%) classified as CPA. Median survival following embolization was 12.5 months for the entire group; 22.7 months in the 33 patients who had segmental or lobar PVT at presentation, compared with 7.1 months in the 10 patients with main PVT (p ¼ 0.001). Conclusions: HAE can be used to treat patients with HCC and PVT with median survival of a year or more and low liver toxicity. Unlike Yttrium 90 radio-embolization, the majority of patients with PVT undergoing HAE maintain their CP status at the time of progression and thus remain candidates for both systemic and loco-regional therapies.
3:18 PM
Abstract No. 285
A retrospective review of technical and clinical outcomes in ruptured hepatocellular carcinoma managed with transcatheter arterial embolization at a North America center M. Rivers-Bowerman1, O. Mironov2, J. Kachura3; 1 Toronto General Hospital, Toronto, Ontario; 2University Health Network, Toronto, Ontario; 3Toronto General Hospital, Toronto, ON Purpose: To evaluate technical and clinical outcomes following transcatheter arterial embolization (TAE) for ruptured hepatocellular carcinoma (HCC). Materials: A retrospective review of patients who had TAE for ruptured HCC from 2006-2015 at a tertiary care center was performed. Demographics, clinical presentation, medical history, laboratory testing, imaging evaluation, embolization technique, and outcomes were assessed. Results: Thirty-five adult patients (22 male, 13 female; mean age, 61 years (range 30-84)) with ruptured HCC underwent 36 TAE procedures. All patients with ruptured HCC presented with abdominal pain and/or syncope. Shock (heart rate 4100)
TUESDAY: Scientific Sessions
30-Day Readmission
’
’
Scientific Session
Tuesday
M. Fritsche, J. Watchmaker, A. Lipnik, S. Mouli, J. Baker, F. Banovac, S. Geevarghese, R. Omary, D. Brown; Vanderbilt University Medical Center, Nashville, TN Purpose: Historically, patients treated with TACE for HCC are observed (OBS) overnight. Starting in 2014, we initiated targeted same-day discharge (DC) based on low estimated morbidity. We tested the hypothesis that DC of selected patients would not increase 30-day readmission rate (30D). Materials: With IRB approval, we reviewed TACE for HCC patients from 7/2013-6/2016. Treatment was Lipiodol-TACE (cTACE) with 50 mg dox/10 mg MMC/particles or drug-eluting embolics (DEE) with 50-75 mg dox/vial. At 3 hours, patients tolerating PO intake and not requiring IV pain meds were considered for DC. The primary outcome measure was 30D for OBS vs DC using Chi-Squared (X2) analysis. The secondary aim was to identify baseline or treatment variables in the table for independent association with 30D via X2. A po0.05 was significant. Results: 191 patients underwent 261 TACE: 30D was not significant between OBS (n ¼ 179, 9.0%) and DC (n ¼ 82, 13.8%, p ¼ 0.33). 30D was not related to agent selected (cTACE 11.0% vs. DEE 7.5%, p ¼ 0.36). Variables associated with 30D were Child-Pugh B/C (X2 ¼ 7.9, po0.01), history of encephalopathy (X2 ¼ 15.4, po0.01) and ascites (X2 ¼ 4.4, po0.05). Patient age (4 or o65), tumor number (1 vs 41), and treatment selection (segmental vs lobar) all had p40.05. Conclusions: OBS does not reduce the risk of 30D. Child-Pugh B/C, ascitic and encephalopathic patients are at the highest risk of 30D.
Baseline
No
Yes
Total
A
112
9
121
B/C Encephalopathy
55
15
70
Child-Pugh class
0.0049*
o0.0001*
Yes
35
14
49
No Ascites
132
10
142
Yes
48
12
60
No
119
12
131
Procedure Data
No
Yes
Total
Modality c-TACE
138
17
155
98
8
106
DEE
3:09 PM
P Value
0.036*
P Value 0.36
Abstract No. 284
Outcome following hepatic artery embolization for HCC in presence of portal vein tumor A. Borgheresi, K. Brown, A. Covey, H. Yarmohammadi, F. Boas, E. Ziv, G. Getrajdman, J. Erinjeri, M. Gonen,
S123
S. Solomon; Memorial Sloan Kettering Cancer Center, New York, NY Purpose: To review long-term outcome of hepatic artery embolization (HAE) using small microspheres in patients presenting with portal vein tumor (PVT) over a 10-year period. Materials: All embolizations performed for HCC between December 2005 and December 2015 were reviewed, identifying 43 patients who had PVT at presentation. Information in the electronic medical record (EMR) along with imaging findings at presentation and following treatment were analyzed retrospectively. Response to treatment was evaluated using mRECIST criteria on multiphase CT obtained 3-5 weeks after treatment and at quarterly intervals thereafter. Liver function was assessed at the same time points and Child-Pugh (CP) score was calculated. Time to progression (TTP) was recorded as well as whether progression was local tumor progression (LTP), distant hepatic progression (DHP), PVT progression, and/or the development of extra-hepatic disease (EHD). Results: Forty (40/43, 95%) patients progressed during a median follow-up of 10 months with a median TTP of 2.9 months. Eleven of the 43 patients (26%) developed EHD, 23 (53%) progressed within the liver with only 2 (5%) demonstrating solely LTP. Six patients (14%) progressed only in the PVT. At the time of progression 27 (27/40, 77%) maintained their initial CP status, including all 5 CPB patients and 22 of 35 (63%) classified as CPA. Median survival following embolization was 12.5 months for the entire group; 22.7 months in the 33 patients who had segmental or lobar PVT at presentation, compared with 7.1 months in the 10 patients with main PVT (p ¼ 0.001). Conclusions: HAE can be used to treat patients with HCC and PVT with median survival of a year or more and low liver toxicity. Unlike Yttrium 90 radio-embolization, the majority of patients with PVT undergoing HAE maintain their CP status at the time of progression and thus remain candidates for both systemic and loco-regional therapies.
3:18 PM
Abstract No. 285
A retrospective review of technical and clinical outcomes in ruptured hepatocellular carcinoma managed with transcatheter arterial embolization at a North America center M. Rivers-Bowerman1, O. Mironov2, J. Kachura3; 1 Toronto General Hospital, Toronto, Ontario; 2University Health Network, Toronto, Ontario; 3Toronto General Hospital, Toronto, ON Purpose: To evaluate technical and clinical outcomes following transcatheter arterial embolization (TAE) for ruptured hepatocellular carcinoma (HCC). Materials: A retrospective review of patients who had TAE for ruptured HCC from 2006-2015 at a tertiary care center was performed. Demographics, clinical presentation, medical history, laboratory testing, imaging evaluation, embolization technique, and outcomes were assessed. Results: Thirty-five adult patients (22 male, 13 female; mean age, 61 years (range 30-84)) with ruptured HCC underwent 36 TAE procedures. All patients with ruptured HCC presented with abdominal pain and/or syncope. Shock (heart rate 4100)
TUESDAY: Scientific Sessions
30-Day Readmission
’