Repeated ultraselective transcatheter arterial chemoembolization for hepatocellular carcinoma with portal vein thrombus.

OBJECTIVES

To investigate the safety and long-term effectiveness of repeated ultraselective transarterial chemoembolization (rusTACE) using a 1.7-Fr-tip microcatheter in hepatocellular carcinoma (HCC) patients with portal vein tumour thrombus (PVTT).

METHODS

This retrospective analysis includes HCC patients with PVTT treated with rusTACE between May 2014 and July 2022. A 1.7-Fr-tip microcatheter was used to perform rusTACE for ultraselective embolization of the tumour-feeding artery. Treatment was repeated at least 2 times within 2 months. Treatment responses, survival rates, adverse event, liver function, and tumour-feeding arteries were assessed.

RESULTS

Twenty patients underwent rusTACE with a mean interval of 42 days between treatments. RusTACE was well-tolerated. Median survival time was 26.1 months, with 1-, 2-, 3-, and 5-year survival rates of 85.0%, 61.0%, 40.9%, and 24.6%, respectively. Complete response (CR) of PVTT was achieved in 75%. Among these, 35% maintained CR of PVTT throughout follow-up (mean, 25.0 months). Univariate analysis showed prognostic factors included Child-Pugh score 5, CR of PVTT, CR of systemic tumours at the end of rusTACE, and liver tumour burden <30%. In 17%, a peribiliary vascular plexus or communicating artery was identified as the tumour-feeding artery.

CONCLUSIONS

RusTACE is a safe and effective treatment option for HCC with PVTT in selected patients (Child-Pugh class A). RusTACE showed a high CR rate and long overall survival. The short interval between treatments and ultraselective embolization of tumour-feeding arteries contributed to favourable outcomes.

ADVANCES IN KNOWLEDGE: RusTACE can be safely performed in HCC with PVTT and has a high local control rate.